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BUILDING [] <br /> <br />MARION COUNTY BUILD NG NSPECT ON <br />senator BId~ No.. 2.25,. <br />220 High Streat NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-='147 <br /> Code-A.Phone 4:30 EM, - 8:so A.M. <br /> <br /> MOBILE HOME [] SEPTIC [] <br /> <br />PERMIT APPLICATION <br /> <br />Situs Address: <br /> <br />Use of SulJding: <br /> <br />Township: <br /> <br />Malting Address: ,~- <br /> <br /> Btec~: Section: <br /> / <br /> Depth: Arem <br /> <br />Width: Acres; <br /> <br />Tax Lot: <br /> <br />Site No.: <br /> <br />Contract City: UGB: <br />Construction Type: OccupanCy; <br /> <br />Subdivision: <br /> /,:/x.? <br />Min, Raqd. Front: <br />SetbackS: ..~. /) <br /> ' Range: <br /> <br /> Irmg, Lot; <br /> ,, <br /> <br />Cross Street: <br /> <br />OccupentLoad; <br /> <br /> / <br /> <br />Left Right ~--' Rear: <br />Side; ,~;~- Side: . <br />Zone: Map: <br /> <br /> Corner: Fleet S/C ~nei <br /> <br />Type of Permit: <br /> <br />New; [] Addition: [] Demo; [] Tach. <br /> <br />Alter: [] Relocation: [] Otc. Chg.: [] Review; [] <br /> <br />Use of Building: <br /> <br />Contractor: Phone: Address; <br /> ? <br /> <br />Home Builder's Registration No,; <br /> <br />RES [] <br /> <br />COM [] <br /> <br />Phone: <br /> <br />Addmsa; <br /> <br />Architect/Engineer; <br />Height of Buirding: No, Stories: Sq. Fi, Main Floor: Sq. Pt. 2ed Floor: Sq. Ft. Garage: , Other; <br />Mobile Home: Width: Length: Water Supply: <br /> <br />Proposed Septic Installation: <br /> Previous Site Evaluation #; <br /> <br /> Type of System; <br /> Test Hales Ready; <br /> Will call when holes ~eady; <br /> <br />Existing Septic System'. <br /> Existing Tank Size; <br /> Existing Drelnfleld Length: <br /> Type of System; <br /> Date Tank Pumped: <br /> <br />Valuation: <br /> <br />$ <br /> <br />( ) I have read this applloattsn In Its entirety and cedity that the stated information <br /> <br /> larnaregisteredbuilderOR( )theauthorlzedrepresentativect <br /> a registered buildec <br /> The work will be per formed by a registered builder. <br /> Other ...... <br /> I agree to build according to the Submitted plans and specifications, the laws of <br /> the state of Oregon and the ordinances of Marion Coanty. <br /> <br />SIGNATU R E OF APPLICANT: ' , ....... <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT,= PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev. 3/87 <br /> <br />Bldg. Fee:. , $ <br />Mobile Ho~e Fee: <br />F eat Surcharge: <br />Zoning Sumherge: <br />State Surcharge: <br />Plans Check Fee; <br />Site Evaluation Fee: .... ,~ ~-, , <br />Septic Permit Fee: <br />DEQ Surcharge: ,Zr:: ~ - ~ /) <br />Technicar Review Fee: <br />Relnspec~ion Fee: <br />Investigation Fee: <br />City Fee: <br />TOTAL FEE; ~r ,~,:r', X ~ <br />RECEIPT NO,; <br /> <br /> <br />