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Receive. d By:. <br /> <br />Zoning Validation: <br /> <br />Date; <br /> <br />BUILDING [] <br /> <br />MARION COUNTY BUILDING INSPEC'rlON <br /> ~enator Bldg. NO, 225 <br /> 220 High b'treet NE <br /> Salem, Oregon 97301 <br /> <br /> MOBILE HOME [] SEPTIC [] PERMIT APPLICATION <br /> <br />Use of SuJlding: ~ <br /> <br />Mailing Address: <br /> <br />Lot; Block: <br />Width: Depth; <br /> <br />Type of Permit: New; ,/~ <br /> Alter: [] <br /> <br />Section; <br />Aree~ <br /> <br />Tax Lot: <br /> <br />Contractor; <br />~oo~ ~uiId~tration' <br /> <br />Contract,~__~.City: UG~ <br />Construction Type: Occupancy: <br /> <br />StJbdivision; <br /> <br />Occupant Load <br /> <br />Min. Reqd. Front: [ Loft Right <br />Set'backs; / Side; SMa: <br /> <br />Township; ReTf~ <br />Acre's.''''-r(~ Irreg. Lot; <br /> <br />TaCh.Review: [] lAseddress;°f Building~(~.h~ <br /> <br />Addition; [] Demo: [] <br /> <br />ReLocation; [] Occ, Chg,; [] <br /> Phone: <br /> <br /> Rear: <br />Map; , <br /> <br />Fleet SiC Zone: <br /> <br />RES ¢ <br />eom ~ <br /> <br />Architect/Engineer: Phone; <br /> <br />Height of Building; <br /> <br />Mobile Home; <br /> <br />No. Stories: <br /> <br />Sq. Ft. Main Floor; E~q. Ft. 2nd Floor: <br />Length.: ~¢)''''''~ , Water 87~¢_~ <br /> <br />Proposed Septic/ostal/ation <br /> Previous Site Evaluation <br /> <br />Type of System; <br />Test Holes Ready; <br />Will cell when holes ready; <br /> <br />Existing Septic System; <br /> Existing Tank Size: <br /> <br />Existing Dralnfield Length: <br /> <br />Type of System: <br /> <br />Date Tank Pumped: <br /> <br />Valuatioo; <br /> <br />$ <br /> <br />Address: <br />,Sq. Ft, Garage: Other'. <br /> <br />Bldg. Fee; <br /> <br />Mobile Home Fee; <br />Fleet Surcharge; <br />Zoning Sumharge: <br />State 8umha~e: <br />Plans Check Fee; <br />Site Evaluatlon Fee: <br />Septic Permit Fee: <br />DEQ Sumharge; <br />Technical Review Fee: <br />Reinspectlon Fee; <br />Investigation Fee: <br />City Fee: <br /> <br />TOTAL FEE: <br /> <br />~-.o@_ <br /> <br /> <br />