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Received By __~ ---~/ MAR'ON COUNTY aU'LO~ ,NS~'(~N ;~ ~F~equirements <br />OIt~ ,lear <br />Zoning ~]alidation. -- 220 High St~t NE <br /> ~ale~ O~go~ ~7)01 <br /> <br /> BUILDING BILE HOME ~ SEPTIC ~ P~RMI~ICATION <br /> Property Owner ~hone:: Mailing Address <br /> <br />Job Address Site No:: .~., , <br /> <br /> O~ 71-/~o,'~- O ~ ~ ?~ Property T~x Lot No H SIC Zo~ <br /> <br />..... Lot:, /2-- B,esk <br />Lot Width / / ~c;;'i:' Irreg Lot <br /> <br />Contractor Bus,ness Name and No ;: <br /> <br />....... ~ ~ ~ F <br />Architect! E nginee?¢,~- <br /> <br />Phone:: Address <br /> <br />Type of Permit New [] <br />eight of Building:: <br /> <br />Mobile Home <br />Width <br /> <br />Proposed Septic Installation <br /> Previous Site EvAluation Cf <br /> <br />Type of System:; <br />Test Holes Ready' <br /> <br />Will daft when holes ready <br /> <br />Existing Septic System <br /> <br />Addition ~ Demo [] Tach <br />Relocation;; [-I Ccc Chg ~ Review:: <br /> <br />No Storie(~ <br />Mobile Home <br />Length <br /> <br />Proposed bedroo.m_$ ~ <br /> <br /> Exlstin9 T~.n_~ _S_ize <br />.__6_xJ~ting Drain¢[9~_ken~h;: <br /> Ty~ of System <br /> Date Tank Pumped <br /> <br />SIONATURE OF APPLICANT ~ ~__~ ~' <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Use of Building RES <br />,~ ~, a / COM <br />Sq, Ft Garage/- 1 Other ~ <br /> <br /> ccupanl¢ Load / Water Supply <br /> C _J <br /> <br /> Mobile Home Fee, <br /> <br />State Surcharge _ ..... /'~__ <br />Plans Check Fee ¢)_..~1_ 0,.~. <br /> <br />Septic Permit Fee <br /> <br />BEQ Surcharge <br /> <br />Technical Review Fee <br /> <br />Reinspection Fee <br /> <br />Investigation Fee:: <br /> <br />City Fee <br /> <br /> <br />