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Received <br /> <br />· city <br /> <br />MARION COUNTY IBUIL[~ <br /> ,en~or Bldg. NI~ <br /> 220 High Sit <br /> ~ ~. / ,~_.I o .... <br /> ..o.~ ~,..' ~ s~dt:' ~ ~ s~: ~ / <br /> <br /> ~ co.~-*-..o.~ 4=go ~.M.- s;oo ~;~RION C0U NTY <br />BUILDING OBILE HOME [] SEPTI~DI~I~I~L~I~CATION <br /> <br />Property Ow n er ;.~,,~ <br /> <br />Job Address: <br /> <br />Lot Width; <br /> ,~ / <br /> <br /> Map: <br /> <br />I Comer; <br /> <br />Cross Street: <br /> <br />Fleet S/C Zone: <br /> <br />Contractor Business Name sod No,; <br />'-~r'~'~ct/Engineer: ........ <br /> <br />Phone; <br /> <br />Address: <br /> <br />Phone: Address: <br /> <br />T~pe of P?mit;/ ~' New: [] Addition; ,~ Demo: L~ Tach. <br />~.~"/~'~_ j Alter: [] Relocation; [] Chg.; <br /> Occ. <br /> [] <br /> Review: <br /> [] <br />~,~T, ~¢) ~.¢¢. ~--,~" ,, <br />Height of~uildin~; /' I No, Stories: I Sq. Fl, Main Floor'. I Sq, Fl. 2nd Floor: <br /> <br />Mobile Home ~ // Mobile Home # Bedrooms; OccupanCy; / <br />Width: Ck'-/'C~k--- I Length:~--' t _~ -- '1 ~ ~ <br /> <br />Proposed Septic Installation: <br />Previous Site Evaluation #: <br /> <br />Type of System: <br /> <br />Test Holes Heady: <br />Will call when holes ready: Proposed Bedrooms; <br />Existing Septic System; <br />Existing Tank Size; <br />Existing Orainfield Length: <br /> Type of System: , <br /> Date Tank Pum,~¢¢~,~,~ - Existing Bedrooms: ,,,,~ <br /> <br />(//') I have read this application in its entirety And certify that the stated information is <br /> true and correct to the best of my knowledge· <br />(.~) I am performing work on a property I own or occupy, <br />(~) ~ am a registered builder OR ( ) the authorized representative of a registered <br /> bd~der, <br />( ) The work wi{I b~ performed by a regulated builder. <br />(/) Other_-_.~ ./¢ Z/ <br />( ~,~-'~I agree to build according to the suited plans a~;~ spe~catiol~', t he laws of <br /> the state of Oregon and the 0 oe~ of M C nty. <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT,: PLUMBING, MECHANICAL, ELECTRICAL <br />MC ~$-6 <br />aev. 12/87 <br /> <br />use of Building: RES [] <br /> <br />Sq, Ft, Oarag.¢ I Other; <br />Occupar~ Load Water ~Su~ply; <br />~e,get~e~: ....... ,__...~] ~5-~Z <br /> <br />Mobile Home Fee; <br />Fleet Surcharge: <br />Zoning Surcharge: <br />State Surcharge: <br />Plans Check Fee: <br /> <br />Site Evaluation Fee; <br /> <br />Septic Permit Fee: <br /> <br />DEQ Surcharge: <br /> <br />Technical Review Fee: <br /> <br />Reinspectlon Fee: <br /> <br />TOTAL FEE'. <br /> <br />RECEIPT NO,: <br /> <br />lO.OD <br /> <br /> <br />