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· · # / ,,~ ~: ~ t/ ~,.,,¢ Salem, amgen 97.301 I Left I Right <br /> <br /> ! ' MARION COUNTV oa -*.p.o.. <br /> <br />Job Address <br /> <br />S~di¥isie~ <br /> <br />Mobile Home Park;; <br /> <br />Section <br /> <br />Lot Width <br /> <br />Contractor Business Name and No// <br />Architect/Engineer <br /> <br />Phone <br /> <br />--"~ling Address;; <br />Site No,:: <br /> <br />Property Tax Lot <br /> <br />Come! <br /> <br />3ros~J Street:: ~- <br />Fleet S/C Zon~ <br /> <br />Total <br /> <br />Phone <br /> <br />Typo of Permit:: New [] Additioe:: -[~"' Der!lo;; <br />,,, ~, ?,,~ ~ Alter ~ Relocation [] Ccc,, Chg <br /> <br /> Height of Building::/- T NO Stories, T Sq Ft, Main Floor <br /> ~l~o~eme//I MoblleHom /- t ,,t¢O~ <br /> <br />Address:: <br /> <br />Address <br /> <br />[] Tach of Building;: RES <br />[] Review [] COM <br /> <br />Sq Ft 2nd Floor <br /> <br /> Previous Site Evaluation #:: <br /> _T~a of System:: <br /> Test Holes Ready <br /> Will call when holes ready, Bedrooms; <br /> <br /> ExlshY~g Tank Size -- -- <br /> Existin~ Drainfield Length' <br /> <br />f ~ I have read this epplto,tIo, i. its entirety .nd .ttify that the St.ted ,n, ~ ~ ~ ¢ <br /> <br />SIGNATURE OF APPLiO~,NT /~ ~ ~ .,~~ City Fee <br /> <br />OTHER PERMI%S REQUIRED BY THIS DEPT,: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev 12187 <br /> <br />TOTAL FEE:: <br /> <br />RECEIPT NO <br /> <br /> <br />