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Received By <br /> <br />City <br />2oning validation <br /> <br />Date <br /> <br />BUILDING [] <br /> <br />MARION COUNTY BUclLDING INSPECTION <br /> <br />[~_Setbaok Regui,reme~nts <br /> <br />Front Rear <br />-~;~t"' Righf <br /> <br /> Senator Bldg,, NO,, 225 <br /> 220 High Street NE <br /> Salem, Oregon 97.3Ol <br /> Phone S88-$147 <br /> <br />MOBILE HOME [] SEPTIC [] <br /> <br />Property Owner <br /> <br />Job Address <br /> <br />PERMIT APPLICATION <br /> <br />Address <br /> <br /> Cross Street <br /> <br />Site NO <br /> <br />Subdivision <br /> <br />Proper~y Tax Lot No <br /> &/6-- <br />Lot <br /> <br />Fleet S/C Zone <br />Block:: <br /> <br />Mobile Home Park Sp #. Total # Spaces <br /> <br />Corner:: <br /> <br />Contractor Business Name and No :; <br /> <br />ArchitectcEngineer <br /> <br />Phone:: <br /> <br />Phone <br /> <br />Address:: <br /> <br />Address <br /> <br />Type of Permit:: New:: [] Addition L~ Demo:: [] Teoh Use of Building RES <br /> Alter [] Relocation [] Occ Chg [] Review [] COM <br /> <br />Height of Building:: No Stories Sci Ft, Main Floor Sq Ft Garage <br /> <br />Mobile Home Mobile Homo <br />Width :: Length :: <br /> <br />Sq Ft 2nd Floor:: <br />Occupancy <br /> <br />Proposed Septic Inetallation <br /> Previous Site Evaluation # <br /> Type of System <br /> <br />Test Holes R?,~dy <br />Will call when holes ready Proposed Bedrooms <br />Existing Septic System:: <br /> <br /> Existing Drainfield Length <br /> <br />T~ II0¢ <br />System:: <br />Date Tank Pumped:: ~'-"~-'?~'~-~ Exletlr~ Sedrooms;; <br /> <br /> Other:: <br />Occupant Load Water ~.,~ply:: <br /> <br />Valuation <br /> <br /> I have read this application in its onttroty and certify that the stated information Is <br /> <br /> Other <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br />MC ~5-6 <br /> <br />BIdg Fee:: <br /> <br />Mobile Home Fee:: <br />Fleet Surcharge <br />Zoning Surcharge <br />State Surcharge:; <br />Plans Check Fee <br />Site Evaluation Fee <br />Septic Permit Fee:: <br />DEQ Surcharge <br />Technical Review Fee:: <br />Reinspection Fee <br />Investigation Fee <br /> <br />City Fee:: <br /> <br />'~'¥A L FEE:: <br />RECEIPT NO:: <br /> <br /> <br />