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City ' <br />Zoning validation; .... <br /> <br />Date: <br /> <br />Property Owner; <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> senator Bldg, NO, 225 <br /> 220 High ,Street NE <br /> ~alem, O[egon 97301 <br /> <br /> Phone 588-5147 <br /> Code-A-Phone 4:30 P.M. - 8=00 <br />BUILDING ~ MOBILE HOME E~ <br /> Phone'. , <br /> <br />Subdivision: <br /> ( ~/,nu,~,/ ,~r.~zVJ,,~,~__.,~(r~, 5/ <br />Mobile Home [5ark: ~ ,. <br /> <br />Section; )i Township: <br />Lot Width; Let Depth; <br /> <br /> Requirements; <br /> ~ity Betback <br /> <br /> J Front: Rear: <br />SEPTIC [] PERMIT APPLICATION <br /> <br /> Mailing Address; ~ <br />Bite No:: // f 4// Cr0s~ Btreet; <br /> <br />Property,Ta~. Lot Np,: <br /> <br />Lot: <br /> <br />corner: <br /> <br />Range:Zoee; <br />A 'res,"' ',-.' ,4. t <br /> '-tt ~ <br /> <br />Fleet B/C Zone; <br /> <br />Block; <br /> <br /> ContraCtOr Business Name and No,; <br /> <br />4~'~'¢~TYP' e' Perrni' New,. ~-~ Addition: ~ <br /> ., .. , ., <br /> <br /> M~ile Home ~obile Home <br /> <br />Phpne: <br />, <br />Phone; <br /> <br />Demo: [] <br />gcc. Chg.: [] <br /> <br />Address: <br /> <br />Address: <br /> <br />Tach, <br />,: Review; [] <br /> <br />Use of Building: <br /> <br />jSq, Ft, Main Floor; <br />,#' Bedrooms; <br /> <br />Sq, Ft, ~nd Floor: <br /> <br />Sq, Ft; Garage: <br /> <br />Occupant Load: <br /> <br />RES El" <br /> <br />COM [] <br /> <br /> Proposed Septic Installation: <br /> Previous Site Evaluation #; <br /> Type of B~stem; <br /> Test Holes Ready: <br /> Will call when holes read~ <br /> Existing Septic System: <br /> Existln~ Tank Size: <br /> Existing Drainfield Leng_th,~ <br /> Typ~ ¢ S~ystem: <br /> <br />..... Date~ Tank Pumped: ~ ! ~ ~ <br /> <br />Proposed Bedrooms: ~ <br /> <br />' Valuation: <br /> <br /> Bldg. Fee; <br /> <br /> Mobile Home Fee; <br /> Fleet Sure?argo: <br /> Zoning Surcharge: <br /> State Surcharge: <br /> Plans Cheek Fee: <br /> Site Evaluation Fee: <br /> Septic Permit Fee: <br /> <br />Other:'I <br /> <br />Water Supply; <br /> <br /> ) Other <br /> <br />OTHER PERMITS REQUIRED BY THIS SEPT,: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br /> Technical Review Fee: <br /> Reinspecti0n Fee; <br /> Investigation Fee: <br /> City Fee: <br /> <br />· TOTAL FEE: <br /> <br /> RECEIPT NO.: <br /> <br />) I am'~oerform~ng work on e property I own or d~euj~y. .... ~- .................................... DE'O '8aTcharge; ,, ...... <br /> <br /> <br />