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~'oning Validatiom <br /> <br />BUILDING [] <br /> <br />MARION CpUNTY BUILDING INSPECTION <br />.Senator Bide, NO, 225 <br />220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-~47 <br /> Code-A-Phone 4;30 EM. - 8:00 A.M, <br /> <br /> MOBILEHOME [] SEPTIC [~ <br /> <br /> Tax Lot; <br /> <br />Use of Buildlng; <br /> <br />MaJJJng Address: <br /> <br />Width: Depth; Area; <br /> <br />PERMIT APPLICATION <br /> <br />Contract C~ly: UGS; <br />Construction Type; Occupancy: <br /> <br />Subdivision <br /> <br />Cross Street; <br /> <br />Occupant Load: <br /> <br />Min. Reqd, Front: <br />Setbacks: <br /> <br />Range: <br /> <br />Irreg. Lot; <br /> <br />Left Ri ht Rear: <br />Side: Si~: <br /> <br />Corner; <br /> <br />Map; <br /> <br />Fleet S/C Zone: <br /> <br />'~pe of Permit: New: [] Addition: [] Demo; [] <br /> <br /> Alter: [] Relocation; [] Occ, Chg,; [] <br /> <br />Phoee; <br /> <br />Tach, <br /> <br />Review: [] <br /> <br />Use of Building: j <br />~/L~)7~_ a~C+.~¢/)¢ RES [] <br /> COM ,,~' <br /> <br />Address'. <br /> <br />Home Butlder~ Registration No,; <br />Architect/Engineer: Phone: Address; <br /> <br />Height of Building; No. Stories; Sq. Ft. Main Floor: Sq, Fl, ged Floor: Sq. Ft. Garage; Other: <br />Mobile Home; Width; Length; Water Supply; <br /> <br />Propose~ Septic installation; <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 Task Size: <br /> Existing Dreinflald Length: <br /> Type of System: <br /> Date Tank Pumped; <br /> <br />Valuation: <br /> <br />$ <br /> <br />( I have read this applicaflon In its entSmy and certify that the stated information <br /> is true and correct to the best of my knowledge. <br />( )(~ r am performir3g work on a property I owr~ or occupy <br /> ~ am e registered builder OR ( ) the suthorized t~p~eseofetive of <br /> a registered builder, <br /> ) The work will be performed by a registered builde~ <br /> ) Other <br /> I agree to build ~ording tp~n?~st~omltted plans and specifications, the laws of <br /> lhe st.te of Oreg;~ ~d~e~,~r~nces of Marion Count, <br /> <br />OTHER PERMITS REQUIRED BY THIS DEP[: PLUMBING, MECHANICAL, ELECTRICAL <br />MC t5-6 <br /> <br />Bide, Fee: <br /> <br />Mobile Home Fee: <br />Fleel Sumharge: <br />Zoning Sumharge: <br />State Sumhergs: <br />Plans Check Fee; <br />Site Evaluation Fee: <br />Septic Permit Fee: <br />DEQ Surcharge; <br />Technical Review Fee; <br />Reinspection Fee: <br />Investigation Fee; <br />City Fee; <br /> <br />TOTAL FEE: <br />RECEIPT NO,; <br /> <br /> <br />