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BUILDING ~'//'MOBILE HOME [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> Send, tot Bldg, No. <br /> 220'High Street NE <br /> Salem, Oregon 972101 <br /> <br /> Phone 588-5147 <br /> Code-A-Phone 4:$0 EM, - 8:00 A,M, <br /> <br /> SEPTIC [] <br /> <br />City Setback Requirements; <br />Front:,~ / Rear: ~'"/' <br />Left ~ ~, R~ghl ,' <br />~de: ,.7.* Side: ~' <br /> <br />PERMIT APPLICATION <br /> <br />Property Owner; <br /> <br />dob Addreee; <br /> <br />Mobile Home Park: <br /> <br />Seotion; <br /> <br />Phone: Maili? Address; <br /> <br />Townehip; ~.t2¢~' Range: <br /> <br />Lot Depth: Acres: <br /> <br />Site No.: <br /> <br />Property Tax Lot No,: <br /> / <br />Lot: ,~ <br /> <br /> Sp. #: <br /> <br />Zone: Map: <br /> <br />Lot Width; ¢~/~ Irreg. Lot; Corner: <br /> <br />C~oss Street; <br /> <br />Fleet S/C Zone; <br /> <br />Block; <br /> <br />~;UtLg!:~{~ H%?ECTION <br /> <br />Contractor BusJnees Name and NO.: <br /> <br />Architect/Engineer: <br /> 4/;~ "1/4'-'" <br /> <br />Type of permit; <br /> <br />Newt O Addition; ~/ Demo: [] Tach, <br />Alter: [] Relocation; [] Ccc. Chg,; [] <br /> <br />tSq, Ft, Main Floor: <br /># Bedrooms: ~L <br /> <br /> Review: [] <br /> <br />Height of Buil,d.~n. Bg: No, Stories: / Sq. Ft. 2nd Floor: Sq, Ft, Garage: Other: <br /> <br />Mobile Home Mobile Home Occupancy; .,.~_ Occupant Load; <br />Width: <br /> <br />Proposed Septic Installation: <br /> Previous Site Evaluation ¢/; <br /> Type of System: <br /> <br />Test Holes Rea~y;. <br />Will call when holes ready: <br /> <br />Prpposed Bedrooms'. <br /> <br /> Exieting Septic System: <br />Existing Tank ~!se; <br />~E,x!~ting Drainfield Length: <br /> Type of Sygtem; <br /> <br />Address; <br /> <br /> RES <br /> <br /> COM <br /> <br />Length: <br /> <br /> Cate Tank Pumped: ....... Existing Bedrooms; <br /> <br /> /~} I have read this Application Jn its entirety and certify that the stated information Is <br /> . true and correct to the best of my knowledge. <br /> f'/'~) I am performing work on a property I own or occupy. <br /> ) [ am a registered builder OR t } the authorized repreeentaPve of a reglstered <br /> builder. <br /> ) The work will bo performed by a registered builder, <br /> ) ... Oth~er o <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, IVlECHANICAL, ELECTRICAL <br /> <br />Water S.upply: <br /> <br />Valuation; <br /> <br />Bldg. Fee: <br /> <br />Mobile Some Fee; <br />Fleet Surcharge; <br />Zoning Surcha~e: <br />State Surcharge: <br />Plans Check Foe: <br />Site Evaluation Fee: <br />Septic Permit Fee: <br />CEO Surcharge: <br />Technical Review Fee; <br />Reinspection Fee; <br />investigation Fee; <br />City Fee: <br /> <br />TOTAL FEE: <br />RECEIPT NO.: <br /> <br /> <br />