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C~ty <br />7on~r~ ~AlJClallOm <br /> <br />Date <br /> <br /> MARION COUNTY BUILDING INSPECTION I City Seth..a~ R~quiremen~ <br /> ~ aldg, No. 22~ / ~ <br /> <br />BUILDING ~ MOBILE ~OME ~ SEPTIC ~ PeRM~ APPLICA~ON <br /> <br />Property Owner;,. ~/,~.~ Phone <br />Job Address. <br /> <br />Subdivision. <br /> <br />,~4~iofl :: t Township <br />Lot WicRh: Lot Depth: <br /> <br />Praperty Tax Lot No <br /> <br />8p #" .... <br /> <br />Zone Map <br />I~reg Lot: Corner <br /> <br />Fleet S~C Zone. <br /> <br />Contract~ BuSiness Name and No <br />Archlt ecl/Engineer- <br /> <br />phoile. <br /> <br />Height of Bulldi~ <br /> <br />New' LJ ,l~dition. [] Demo [] Teeh <br />Alter ~1 Pek)cat/on: ~' O~,, Chg /~ ReView <br /> <br />Use o)" Building. <br /> <br />No. Stories I ~q' [=t, Main Fk)o~': / ~1 Ft, :End I~oc~'. <br />Mobile Home ~ ~ ~. ~ ~y: <br />Lo " :_.. } . ........ <br /> <br />[] <br /> <br /> aq. Ft- Garacje Other <br /> Occupant Load <br /> <br />. Type of System,, <br /> <br />Test Holes Ready: <br />Will ~all wf'len holes ready ..~(~'~osed eedrooma <br /> <br />Existing Septic System,, <br />Existln~l, Tank Size. <br />Ex!~r~Drainfleld Length- <br />~/p~, ct System, <br /> <br />t(',~ ) I agree to bulkl s, cCO¢'dlng tO the Submi~ed plans and specifications, the laws <br /> <br />OTHER PERMITS RI~QUIREO BY ?His DEPT: PLUMBING, MECHANICAL. ELECTRICAL <br />MC 15,6 <br /> <br /> VW~ Supply <br /> Valuation: ~ <br /> <br />M~ile H~e Fe~ <br />F~et Su~a~,, <br />~ 8umhar~ <br />~ta~ ~utcharg~ ..... <br />P[~S Ch~k F~:: <br /> <br />Septic PermE ~ <br />OEQ 8u~a~e; <br />T~i ~ F~ <br />~k)n ~e ~-- <br /> <br />City F~ <br /> <br />~OTAL FEE: <br /> <br />RECEIPT NO: <br /> <br /> <br />