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Received <br /> <br />City <br />Zoning Validation. <br /> <br />BUILDING [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br />~enator Slag. No. 22g <br />220 High Straet NE <br /> Salem, O~egon 97301 <br /> <br /> Phone 588-5147 <br /> Code-A-Phone 4:30 P.M. - S:S0 A.M, <br /> MOraLE HOME [] S;PT;C [~ <br /> <br /> City Setback Requlreme,n,m <br /> Front: ~.O) Rear: <br /> <br />J Side: ~ Side: <br />PERMIT APPLICATION <br /> <br />Property Owner: Phone; Mailing Address: <br /> <br />Job Address: <br /> <br />Site No,; <br /> <br />Properq( Tax Lot No.: <br /> <br />Cross Street; <br /> <br />Fleet SIC Zone: <br /> <br />Subdivision: Lot: Block; <br />Mobile Home Park; Sp, #: Total # Spaces; <br /> Zone; Map; <br /> <br />Section; <br /> <br />Lot Width; <br /> <br />Township; <br /> <br />Lot Depth; <br /> <br />Range: <br />Acres: <br /> <br />Irreg, Lot; <br /> <br />Address: <br /> <br />Architect/Engineer: Phone; <br /> <br />Type of Permit: New: ~ Addition: [] Demo; [~ Tach. Use of Building; RES ,~' <br />~.~N"~-TJ~i,~..'T~ Alter: [] Relocation; [] Ccc. Chg.: ~ Review: [] ~__.~_(_~,. COM ~ <br />Height of Building; Sq. Ft. 2nd Floor: Sq. Ft. Garage; <br /> <br />Mobile Home <br />Width; <br /> <br />inc. Stories: <br /> <br /> Lrvle°nb~lt(~: "° m e <br /> <br />Sq, ft, Main Floor: <br /> Bedrooms: <br /> <br />Occupancy; <br /> <br />Occupant Load; <br /> <br />Valuation: <br /> <br />Proposed Septic Installation: <br /> Previous Site Evaluation #: I 0 ~- ~ <br /> Type of System; <br /> <br />Test Holes Ready: <br />Will call when holes read.y.~ <br /> <br />Existing Septic System: <br />Existing Tank Size; <br /> <br />Proposed Bedrooms; <br /> <br />Exiating Dreinfield Length: <br /> <br />Type Ct System: <br /> <br />Date Tank pv,m. ped; <br /> <br />Existing Bedrooms: <br /> <br />( ) i have read this appllcagon in its entirety and certify that the stated Joformation is <br /> true and correct to the best of my knowledge. <br />( ) I am performing work on a property I own ct OCCUpy, <br />* ( ) I am a registered builder OR ( ) the ~uthorized representative of a registered <br /> builder. <br />( ) The WOrk WIH be performed by ~ registered builder, <br />( ) Other <br />' ( ) 1 agree to build according to the submi~d plans and specifications, the laws of <br /> the state of Oregon and of Mad cunt . <br /> <br /> £/ <br /> 7 <br /> OTHER PERMITS REQUIRED BY T~S DEPT.: PLUMBING ME4ANiCAL, ELECTR CAL <br /> MC ~5-6 <br /> Rev, 1;~/87 <br /> <br />$. <br /> <br />Bldg. Fee: S- <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 />Reinspeofion Fee; <br />Investigation Fee; <br />City Fee; ~tL' '~--- <br />TOTAL FEE: ~ t '~'~_ '~ ~- <br /> <br />RECEIPT NO,; <br /> <br /> <br />