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BUILDING [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High ~'ffiet NE <br /> <br /> MOBILE NOME [] <br /> <br />City Setback Requ{rement~; <br /> <br />SEPTIC ~-'~ERMIT APPLICATION <br /> <br />Mobile Homo f:~rk: t~ ~/~, ~ ~L --- <br /> <br />Lot W)dth~ LOt Depth; .... Acres"' Co~ner; <br /> / 2_0 <br /> <br />Erope~ty Tax Lot No,,;; <br /> <br />Lot" <br /> .... <br />Sp- ~: <br /> <br />Fleet S/C: Zone: <br /> <br />Total ~/ <br /> <br />Height oi' t~ilding, <br /> <br />Mobile Horrle '" <br />Width,, ~ / <br /> <br /> ,eroPose~ .~t~ ~n~tailat.~n. <br /> Prev~s ~i~ E~l~tton <br /> <br /> Te~t ~0~ ~y: <br /> <br /> Existing ~ep~ <br /> <br />OTHER PERM~ REQUIRED ~Y THI~ DEP~: P~MBI~G, MECHA~0~, ELE~ICAL <br /> <br /> g~g, Foe: $ .......... <br /> <br />~et Surcharge:: <br />Z~i~ Surcharge'. .... <br />State Surcharge:: <br />Plans Ch~k <br /> <br />Site E~luat~n ~e' <br /> <br />DEQ Su~h~rge <br />T~hnt~l Rev~ <br />Relnsp~ Fee' <br />In~st~at~ <br /> <br />RECEIPT <br /> <br /> <br />