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BUiLDiNG ~JMOBILE HOME [] SEPTIC [] PERMIT APPUCAT~ON <br /> <br />Property Owner <br /> <br />Job Address <br /> <br />Subdivision <br /> <br />Mobile Home Park:: <br /> <br />Mailing Ad,dress <br /> <br />Site No <br /> <br />Property Tax Lot N~o <br /> <br />Lot <br /> <br />Cross Street <br /> <br />Fleet S/C Zone <br /> <br />Block <br /> <br />Sp #;: Total # Spaces <br /> <br />Zone Map <br />Irreg Lot Corner:: <br /> <br />I ~r~ch'~est/Enginee~r ', <br /> <br />Phone:: <br /> <br />Type o.f..P~ mit[ <br /> //~ , <br /> <br />NOW Addition:: [] Demo:: [] Tssh <br />Alter [~ Relocation [~ Ccc Chg ~ Review [] <br /> <br />Height of Building:: <br /> <br />Mobile Home <br />Width:; <br /> <br />No Stories <br /> <br />Sq Ft Main Floor:: <br /> <br />Sq Ft 2nd Floor:: <br /> <br />Use of <br /> <br />RES [] <br /> <br />COM [;~ <br /> <br />Sq Fl, Garage Other:: <br />Occupant Load:: Water Supply:: <br /> <br />Mobile Rome ¢ Bedrooms Occupancy:: <br />Length:: <br /> <br />Proposed Septic Installation <br />Previous Site Evaluation # <br />Type of Sy. stem <br />Test Holes Ready <br />WIIJ call when holes ready Proposed Bedrooms <br />Existing Septic System:: <br />Existing Tank Size <br /> <br />Existing Drainfleld Leng~.l~_ ....... <br />Typ~!.S~stem <br />Date Tank Pumped:: Existing Bedrooms:: <br /> <br /> I have read this application in its entirety and certify that the steed information is <br /> true and correct to the best of my knOWledge <br />t ) I am performing work on a property I own or occupy <br />( ) I am a reglmered builder OR t ) the authorized representative of a registered <br /> budder <br />t ~' ) The work will be performed by ~ registered builder <br />t ) Other <br />( ~ ) I agree tong to the submitted plans and specifications= the laws of <br /> the st ordinances of Marion County <br /> <br />SISNATUR ~'"'='~T ~ ~ ~ ~ ~ ~'~ <br />OTHER PERMITS REQUIRED BY THIS DEPT,:: PLUMBING. MECHANICAL, ELECTRICAL <br />MC ~S-6 <br />Rev 12/87 <br /> <br />Valuation' <br /> <br />Mobile Home Fee <br />Fleet Surcharge:: ,~ (~'~/'/ <br />Zoning Surcharge:: <br /> <br />State Surcharge <br />Pines Check Fee /TJX' ''~'~ <br />Site Evaluation Fee:: <br /> <br />Septic Permit Fee:: <br /> <br />DEQ Surcharge <br /> <br />Technical Review Fee <br /> <br />Rainspection Fee <br /> <br />Investigation Fee <br /> <br />City Fee:: <br /> <br />TOTAL FEE:: .,/~'~- <br /> <br />RECEIPT NO <br /> <br /> <br />