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~'~'~~ ~='L.'~ iON COUNTY BUILDING INSPECTION <br />City ~.~,~ ., l~.~/ Senator Bldg. No. 225 <br />Zoning Valid[~tl¢~: , ,--,,,,~ <br /> <br /> City Setback Requirements; <br /> <br /> 220 High Stra~t ~la Front; Rear; <br /> Salem, Oregon 97301 L~- Right <br />Date: Phone 588.$147 Side; Side; <br /> ~ ~r~[~N 00U~T'~ Cod~A-Phone 4:3~ RM.- 8:00 A.M- <br /> <br /> APPL!CA~IO~~ <br /> Property Owner: , ~, [ .... I Phon~'; I Mailing ~dmSS: /~/~ [2 F~ <br /> <br /> Job A~d~ss: ' ' Site No.: ' Cros~ Street; <br /> 13208 Donald Rd. NE Aurora 97002 ~~ ~ <br /> <br />Property Tax LOt NO.: <br /> <br />Lot: <br /> <br />Fleet S/C Zone: <br /> <br />Block; <br /> <br />Mobile Homo Park: Sp, #: Total # Spaces: <br /> <br />Sectiom Township; <br /> 15 4s 3 <br /> <br />Lot Depth: <br /> <br />Zone: Map: <br />Irreg. Lot; Corner; <br /> <br />Lot Width: <br /> <br />Contractor Business Name and No,: Phone; Address; <br />Architect/Engineer; Phone: Addresa: <br /> <br />Type of Permit; New: [] Addition; [] Demo: [] Tach. Use of Building; RES X~ <br /> <br /> Alter: [] Relocation; [] Occ, Chg.; [] Review: f'l COM [] <br /> SS-Loan <br /> <br />Height of Building: NO. Stories: Sq. FI, Main Floor: Sq. FI. 2nd Floor: Sq. Ft. Garage: Other'. <br /> <br />Mobile Home Occupancy: Occupant Load: <br />Width: <br /> <br />Mobile Home <br />Length: <br /> <br />Proposed Septic Installation; <br />Previous Site Evaluation #: <br /> <br /> Test Holes Ready: <br /> <br />Will call when holes ready__~ <br /> <br />Existing Septic System; <br /> Existing Tank Size: <br /> Existing Drainfield Length: <br /> <br />Proposed Bedrooms: <br /> <br />Valuation: $ <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: 3-00.00 <br /> <br />DEQ Surcharge: <br />Technical Review Fee; <br />Reinspec~ion Fee: <br />Investigation Fee: <br />City Fee; <br />TOTAL FEE: ~¢2O~__ <br />RECEIPT NO,; <br /> <br />Type of System: <br />DateTank Pump~ai ~ Exi~ing Bedrooms; <br /> <br />i have reed this application In Its entirety and certify that the stated information is <br />true a~d correct to the best of my knowledge, <br /> <br />builder· <br /> <br />Other ..... <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br />MC <br />Rev. 12287 <br /> <br /> <br />