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~¢.ceived By. -~ <br />City <br />Zoning Validation- _ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> ~o HI¢ Street ~JE <br /> <br />I Clt¥..,..Setba_c_k Requirem,en.~ts: <br /> <br />HOME [] 8EPTIC.~ PERMIT APPLICATION <br /> Sp ~ T~[ ~ ~paces- <br /> <br />Lot Width?/ LOt Depth; ~' Acre$~X~ <br /> <br />Coe~'act~r Business Name end NO <br /> <br />Archlt¢c~ ir:nglr~eer <br /> <br />Phone .... <br /> <br />Address <br /> <br />Addres¢; <br /> <br />NeW. r-i Addition,,, [] De,mo <br />Alter ~ Relocation' L~I 0oo Chg <br /> <br />No_ Stet)es <br /> <br />rv~bile Home <br />Length:: <br /> <br />Sq Ft Main FloOr <br /> <br />Proposed Septic Jnstallat~o~ <br />Previous Site Evaluation # <br /> <br />Existing Dralnfield Length <br /> <br />Date Tank Pum~;; <br /> <br /> Use of E~siidin~ ..... <br />[] <br /> 8q. Ft Garage: <br /> Occupant Load <br /> <br /> fRES E~ <br /> OOr~ [] <br /> <br />Other <br /> <br />Water Suppfy/~- <br /> ~/e t/ <br /> <br />valu~tlon $. <br /> <br />8idg, Fee <br /> <br />MOb~e Home Fee <br /> <br />Flee! Surcharge: <br /> <br />State S~rch~rg~,, <br />Plans Check Fee <br />Site ~aluation Fee; <br />Septic Pmmit Fee: <br />DEQ Su~harge; <br />Technical Review Fee <br />Rein~pecti~ Fee <br />lnvesiigati~ F~ <br />City Fee: ............... <br />TOTAL FEE _~__ <br />R~CEIPT NO <br /> <br /> <br />