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Re'c~iv~d S~: Y ~ MARION COUNTY BUILDING INSPECTION <br /> <br />Zoning <br /> <br />BUILDING [] <br /> <br /> senator Bldg. NO. 225 <br /> 220 Higll Street NE <br /> selem~ Oregon 97301 <br /> <br /> Phone 588-$147 <br /> Code-A-Phone 4:30 EM, - 8:00 A.M. <br /> <br />MOBILE HOME [] SEPTIC'~ <br /> <br />Property Owner' <br /> <br />Mobile Home Park: <br /> <br />Phone: <br /> <br />Site No.: <br /> <br /> PERMIT APPLICATION <br />Mailing Address: ~?z~/Z~~ ~.A,4E:~' <br /> <br />Property Tax Lot No,; <br /> <br />Lot: <br /> <br />Sp, #: <br /> <br />Section: Range: Zone: Map: <br /> <br />Cross Street; <br /> <br />Fleet S/C Zone: <br />Block:~. <br /> <br />Lot Width; Lot Depth'. Acres: <br /> <br />Irreg, Lot; Corner; <br /> <br />Phone: <br /> <br />iAddress: <br /> <br />1New: ¢ Addition: [] Demo; <br /> I.Alter: [] Relocation: [] Ccc, Oho,; <br /> <br /> Height of Building; No. Stories: <br /> '¢' F-z( / <br /> <br />Mobile Home <br />Width; <br /> <br />Proposed Septic Installation: <br />Previous Site Evaluation #; <br /> <br />Test Holes <br /> <br /> Sq. Ft. Main Floor; <br /> <br />Mobile Home # Sedrooms: <br />Length: ~'0 , ~ <br /> <br />Tach, <br /> <br />Review; <br /> <br />Sq, Ft, 2nd Floor; <br /> <br />Occupancy: <br /> / <br /> <br />Valuation: $_ <br /> <br />Bldg, Fee: $_ <br />Mobile Home Fee: <br /> <br />Will cali when holes ready: Pro,~osed Bedrooms: <br />Existing Septic System: <br /> Tank Size; <br /> Drainfield Length; <br />Type of System! ...... <br /> Bedrooms: <br /> <br />Fleet Surcharge: <br /> <br />Zoning Surcharge: <br /> <br />State Surcharge'. <br /> <br />Plans Check Fee; <br /> <br />Site Evaluation Fee; <br /> <br />S REQUIRED BY Tn~7~' DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Septic Permit Fee; <br />DEQ Surcharge: <br />Technical Review Fee: <br /> <br />Reinspeotion Fee; <br />Investigation Fee: ,/' <br /> <br />TOTAL FEE: ~ l~'c~ <br /> <br /> <br />