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62[ '-/ -/ Salem, Oregon 97301 ILeft Right <br /> <br /> BUILDING ~ MOBILE HOME ~ SEPTIC ~ PERMIT APPL ATIO <br />Property Owner: ~ ~0~ Phone: Address; <br /> <br />Subdivision; <br /> <br />Property Tax Lot Ne,; <br />d¢ .57 -,DrT D <br />Lot; ~ <br /> <br />Cross Street: <br /> <br />Fleet $/C Zone: <br /> <br />J~ Loi";~/idth:[ic~J LOt [ ~.~1 ~ 'J'"~ ~-. Depth; ~ A~'es: Irreg:,~,~t:. <br /> <br />Typ? of Permit~: , New! ,~'-'" Addition; [] Demo: [] <br /> Alter: J'") Relocation; [] Ccc- [] <br /> Chg,; <br /> <br />Height of Building: No, Stories: I 8q, Ft, Main Floor: <br />Mobile Home Mobile Home { ¢ Bedroomg; <br />Width; Length; <br /> <br />Tach. <br /> <br />Review: <br /> <br />Sq. Ft, 2ed Floor; <br /> <br />OCCUpancy; <br /> <br />Use of Building: RES ~ <br /> <br />Sq. Ft, Garage: Other; <br />Occupant Load: Water Supply: <br /> <br />Proposed S6~ptlc Installat~: <br />Pravtou9 Slte Ev~luatiOe et: <br /> <br />Existing <br /> Tank Size: <br /> <br />Bedrooms: <br /> <br />Existing Drainfield Length; <br /> <br />Sate Tank Pumped: <br /> <br />Existie9 Bedrooms; <br /> <br />Bldg. Fee; <br /> <br />Mobile Home Fee; <br /> <br />Fleet Surcharge: <br /> <br />Zoning Surcharge: <br /> <br />Ste, te Surcharge'. <br /> <br />Plans Check Fee; <br /> <br />( ~)' /havereadthlsappli~ationinltsentiretyandcertlfyth~tthestatedinform~tionis <br /> .,,,ti'ua and correct to the best of my knowledge. <br />( ~,~"3 I am pedormtng work on s property I ~n er occupy, <br /> <br />( )~ Other __ <br />( ~ I ~gree to build according to the submitted plans ~nd speeificatio~ls, the laws of <br /> the state of Oregon and the ordinances Marion County, <br /> <br />MC 15-6 <br />R~, 12/87 <br /> <br />Site Evaluation Fee; <br /> <br />Septic Permit Fee; <br />DEe Surcharge; ~b"'~ ' <br />Technical Review Fee: <br />Reinspectiofl Fee: <br /> <br />;it~;go~tion ,co: F'0 ~. <br /> <br /> <br />