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BUILDING [] MOBILE HOME [] SEPTIC [] <br /> <br />S ,!P 30 1987 <br /> <br />MARIJON COUNTY <br /> INSPECTION <br /> <br />Mailing Address: <br /> <br />Tax Lot: <br /> <br />Site No,; <br /> <br />Contract City: <br /> <br />Coeatruction Type'. <br /> <br />Min. Reqd. Front; <br />Setbacks: ~ <br /> <br /> Cross Street; <br />UGB; <br />Occupancy; Occupant Load: <br /> <br />Left / Right Rear ~,. <br />Side; ~ Side: 5 ~ <br /> <br />Lot: Block; Section: Township: <br /> Depth; Area: Acres: Irreg. Lot: Corner: Fleet S/C Zone: <br /> <br />,e of Permit; <br /> <br />New; ~ Addition: [] <br />Alter; [] Relocation'. [] <br /> <br />Contr ctor: <br /> <br />Zone; Map; <br /> <br /> Demo: [] Tach. I UseofSullding; RES ~ <br />Ccc, Chg.: [] Review: [] ~,'~3~z'~'43 ~ ~%- COM [] <br />Ph ' ~ -" ..... % Address: <br /> <br /> T <br /> Phone; <br /> <br />Sq. Ft. Main <br /> <br /> Address; <br /> <br />Sq, Ft. 2sd Floor; Sq. Ft. Garage; . Other; <br />Water Supply; <br /> <br />Home Builder's Registration N/~,~/~ <br />~crchitect/Engieeer;fv//¢__, <br /> <br /> ht of Building:/! NO, Stories; <br /> ¢,fl. ,! <br />Mobile Home: Width: <br /> <br /> Proposed Septic Installation: <br /> Previous Site Evaluation ¢; <br /> Type of System'. <br /> Test Holes Ready: <br /> Will call when holes ready; <br /> <br /> Existing Septic System: <br /> Existln9 Tank Size: <br /> Existing Drainfleld Length; <br /> Type of System: <br /> Date Tank Pumped: <br /> <br />( ~-- I have reed this aDDlice, tion in its entirety and certify that the stated information <br /> is true and correct to the best of my knowledge. <br /> <br /> I am a registered builder OR ( ) tho authorized representative of <br /> a registered builder, <br /> <br />( Other. <br /> <br />Valuation: Bldg. Fee: $ ,-:~)~ '-'~-~) <br />$ ~00, O0 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 /> # <br /> Technical Review Fee: <br /> <br /> Reinspection Fee; <br /> <br /> Investigation Fee; <br /> City Fee: °'2' "~'~ <br /> TOTAL FEE: C-~. <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT,; PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15,6 <br />Rev. 3/87 <br /> <br /> <br />