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Received By <br /> <br />City <br />Zoning Validation <br /> <br />Date <br /> <br /> MARION COUNTY BUILDING INSPECTION I City SStb.~?!( Requirements <br /> <br /> 220 High Street NE Right <br /> Salem, Oregon 97301 ~e~-t- <br /> Phone 588-5147 _ Side:; S de:: <br /> <br />BUILDING [] MOBILE HOME [] SEPTIC E~ PERMIT APPLICATION <br /> <br /> Phone <br />Property Owner~. <br /> <br />Job Address ~-- <br />Subdivision <br /> <br />'~obile Home Park <br /> <br /> Mailing Address:: <br /> <br />Site No:: <br /> <br />Property Tax Lot No <br /> <br />lot:: <br /> <br />Sp # <br /> <br />Cross Street <br /> <br />Fleet S/C Zone <br /> <br />ao~k7 ............ <br /> <br />Total # Spaces <br /> <br />Lot Width:: <br /> <br />Township Range Zone <br />Lot~.Depth::~ ~,-" Acres:: Irreg Lot:: <br /> <br />Map <br /> <br />Corner <br /> <br />Contractor Bueiness Name and No <br /> <br />Phone <br /> <br />Phone <br /> <br />Address:: <br /> <br />Address:: <br /> <br />Type of Permit New' [] Addition [] Demo Use of Building RES L~ <br /> Alter [] Relocation:: ~ Ccc Chg SCM [] <br /> <br />Height of Building No Stories Sq Ft Main FLOOr:: Sq Ft Garage Other <br /> <br />Mobile Home <br />Width 'Z- '* <br /> <br />Mobile Home <br /> <br /> [][]TechReview [] <br /> Sg Ft 2nd Floor <br /># Bedrooms Occupancy:: Occupant Load <br /> <br />Proposed Septic Installation <br />Previous Site Evaluation ~ <br /> <br /> Type of System, <br /> Test _Hol.e_s_ R~ady:: <br /> Will call when holes ready .,P.r.?posed Bedrooms <br />Existing Septic System <br />Existing Tank Size ? ,.~¢~_._ <br />Exist_in_g, Dreinfield Length <br />Type of System <br /> Date T~a?k~,~umped;: ~//~'~¢'~/;~ Existing Sedrooms <br /> <br />Water Supply <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br />MO 15-6 <br />ROy 12f87 <br /> <br />Bldg Fee:: <br /> <br />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 />Technical Review Fee <br />Reinspection Fee <br />I~vestigation Fee <br />City Fee <br /> <br />TOTAL FEE:: <br />RECEIPT NO :: <br /> <br /> <br />