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B City of Aumsville <br />Received ~; ____ <br /> MARION COUNTY BUII~i~ING INSPECTION <br />City, Re $ ident ~¢t .rr Bldg. No- 225 <br />OBte: July 20~ 19~ ~ ~ ~A Phone~8~147 <br /> <br />[C!~Y ~,e. tback Requirements; <br /> Front: 20 Rear; 5 <br /> ~ -- Right <br /> Side; 5 Side: 5 <br /> <br />BUILDING~Rid~I~I0~iOME [] SEPTIC [] PERMIT APPLICATION <br /> <br />-~o~';'i~' Owner~ BurlLD{~ G iN $ P EOT 0~oe~': Mailing Address: ................... <br />Ralph Surfer 588-2373. P.O.Box ]2533 <br />940 9th Street, Aumsville FI~ee~'~ <br />Pmpeny T~ Lot No,; <br /> <br /> Subdivision: ~t: Block; <br /> DelMar III 2 5 <br /> Mobile Home Park: 8~ ¢: Total ¢ Spaces; <br /> Section: ~ownshlp; Range; Zone: Map: <br /> Lot Width: Lot Depth: Acres: Irreg. Lot: Corner; <br /> 74 ' 1 O0 ~ No <br /> <br />Contractor Business Name and NO.: <br /> Ralph Sutter <br /> <br />Architect/Engineer; <br /> N/A <br /> <br />43505 <br /> <br />Phone'. <br />588-2373 <br /> <br />Address: <br />P.O. Box 12533, <br />Address; <br /> <br />Salemr 97309 <br /> <br />Type of Permit: <br /> <br />Height of Building; <br /> 13' <br /> <br />New: [] Addition: [] Demo: [] Tach. <br />Alter: [] Relocation: [] Ccc, Chg,; [] Review: [] <br /> <br />No. Stories: <br /> <br />Sq. Ft. Main Floor: <br /> 1003 <br /> <br />Sq, Ft 2nd Floor: <br /> <br />Uae of Building: <br />Residence <br /> <br />8q. Ft, Garage; <br /> 312 <br /> <br />Mobile Home Mobile Home # Bedrooms: Occupancy; Occupant Load; <br />Width: Length: 3 <br /> <br /> RES [] <br /> <br /> COM ~ <br /> <br />,,, Other; <br /> Water Supply: <br /> City <br /> <br />Proposed Septic Installation: <br />Previous Site Evaluation ¢: <br /> <br /> Type of System: <br /> Test Holes Ready; <br /> Will call when holes ready: Proposed Bedrooms; <br /> Existing Septic System: <br /> _ Exlati.n~ Tank Size; <br /> Existing Drainfield Lena!hi. <br /> _~..p,~,, pf System; <br /> Date Tank Puma. ed: Existing Bedrooms: <br /> <br />(~"~f have read this application in its entirety end Certify that the stated information is <br /> e and correct to the best of my knowledge. <br />(,¢,,"~,,,J-~m performing work on ~ property I own or oCCupy. <br />(.~/' I am a feglstefed builder OR ( ) the authorized repreaentaSve of a registered <br /> <br /> ) The work wil~ be performed by a registered builder. <br /> ) <br />(.~'" I agree to butld aCCOrding to the submitted plans end specifications, the laws of <br /> the state of Oregon end the ordinances of Ion u <br /> <br />SIGNATURE OF APPLICANT' <br /> <br />OTHER PERMITS REQUIRED BCTHIS DEPT.. PLUMBING, MECHANICAL, ELECTRICAL <br />MC 1S-6 <br />Rev. 12187 <br /> <br />Valuation: $ 30r 000. <br /> <br />Bldg. Fee: <br />Mobile Home Fee: <br />Fleet Surcharge: 3,84 <br />Zoning Surcharge: <br />State Surcharge: __~.6.5_ <br />Plans Check Fee: ] 2~5 <br />Site Evaluation Fee: <br />Septic Permit Fee; <br />DEQ Surcharge: <br />Technical Review Fee; <br />Reinspection Fee: <br />Investigation Fee: <br />City Fee: 9.6,5 .... <br />TOTAL FEE: '~4 1 . 5 q <br />RECEIPT NO,; 33 ] 5 ....... <br /> <br /> <br />