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~eceived By __ MARION COUNTY BUILDING INSPECTION City Setback R~equirements <br />City ~'enator Bldg, No- 225 <br />Zoning Validation 220 High Street NE Front Rear <br /> Salema Oregon 973m ~ Right <br />Date Phone S88~147 [ 9ids:: Side <br /> Cod~A-Phone 4~30 RM. · 8:00 A.M. <br /> <br /> MOBILE HOME ~ SEPTIC ~ <br /> <br />BUILDING [] <br /> <br /> PERMIT APPLICATION <br /> <br />Phone:: Mailing A~idrese ~-,','~C~ '~ ,~ ~ ~ O ,, ~ ,'~ ~- ~ ~ O <br /> <br /> Site No Cross Street <br /> <br /> .... <br /> Property Tax Lot No:: Fleet SiC Zone <br /> <br /> Lot ~lock <br /> Sp ~ Total ~ Spaces <br /> ' Zone Map <br /> Irreg Lot Corner:: <br /> <br />Property Owner <br /> <br />Job Address <br /> <br /> Subdivision <br /> <br />-~obile Home Park:: <br /> <br />Section <br /> <br />Lot Width <br /> <br />Township:: Range <br />iD $ <br />Lot Depth ~ Acres <br />'Zoo <br /> <br />Contractor Business Name and No:: <br />[.Ai~hiteettEnginee~' ' <br /> <br />Phone <br /> <br />Phone <br /> <br />-~AAdddress <br /> dress:; <br /> <br />Type of Permit ~ New:: [] Addition <br /> Alter ~ Relocation <br /> <br />Height of Building:: No Stories <br /> <br />Mepile Hems' Mobile Rome <br />Width:: Length <br /> <br />[]Demo 0 Tach, <br />~ Ccc Chg ~ Review;: [] <br /> Sq Ft Main Floor Sq Ft 2nd Floor:: <br /> <br /> ¢- Bedrooms::.,,.,TM / Occup'ancy <br /> <br />Proposed Septic Installation:: <br />Previous Site Evaluation # <br /> <br />Type of System <br /> <br />Test Holes Ready <br />Will call when holes ready:; Proposed Bedrooms:: <br /> <br /> Existing Septic System <br /> Existing Tank Size .,'~ <br />__~infi;~ Length <br />Type of System;: ~ ~_~~~E <br />Date Tank Pumped <br /> <br />Use of Buiiding RES /;~;I <br /> eOM ff <br /> <br />Sq Ft Garage Other <br />Occupant Load¢¥ ~ Supply;\ <br />Valuation $ <br /> <br />builder <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br />MC ts-6 <br />Rev 12/87 <br /> <br />Bldg Fee <br /> <br />Mobile Home Fee <br /> <br />Fleet Surcharge;: <br /> <br />Zoning Surcharge <br /> <br />State Surcharge <br /> <br />Plane Check Fee:; <br /> <br />Site Evaluation Fee <br /> <br />Septic Permit Fee:: <br /> <br />DEQ Surcharge <br /> <br />Technlaa~ Review Fee <br /> <br />Reinspection Fee:: <br /> <br />Investigation Fee <br /> <br />City Fee:: <br /> <br />TOTAL FEE <br /> <br />RECEIPT NO <br /> <br /> <br />