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Received Sy: <br /> <br />Zoning Validation; <br /> <br />Data'. <br /> <br />BUILDING [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br />Senator Bldg, No. 225 <br />220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone $88~147 <br /> Code-A-Phone 4:30 RM, - 8:00 A,M. <br /> <br /> MOBILE HOME [] SEPTIC [] PERMITAPPLICATION <br /> <br />Owner; Tax Lot: <br /> Br±ar~ Sparks #6 <br /> Site No,: Cross Street; <br /> <br />Situs Address: <br /> <br /> 150 Santiem Avenue <br /> <br />Contract Ci~: <br /> <br />UGB: <br /> <br />Use of Building: Construction '~pe; Occupancy: Occupant Load; <br /> ]~esident J_al <br /> <br />Mailing Address: <br /> 1220 Mop, mouth #39 <br /> Independence, Or. 97351 <br /> <br />Block; Section <br />Depth: Area; <br /> <br />tTownship: <br /> <br />lot; <br /> <br />Min. Reqd. Front: <br />Setbacks: <br /> <br />Irreg. Lot: <br /> <br />Width: <br /> <br />Left Right Rear: <br />Side: Side; <br /> <br />Map: <br /> <br />Fleet S/C Zone: <br /> <br />Type of Permit: New: [] Addition; <br /> Alter; [] Relocation: <br /> <br />Contractor; <br /> <br />Ccc. Chg.: [] <br /> <br />Tach. <br /> <br />Review: [] <br /> <br />Use of Building: <br /> <br />Address: <br /> <br />RES [] <br /> <br />COM Lq <br /> <br />Home Buildrs Registration No,; <br /> <br />Architect/Engineer; <br /> <br />Height of Buildi~g: <br /> <br />, No. Stories: <br /> <br />Phone; <br /> <br />Sq. Ft. Main Floor; <br /> <br />Address; <br /> <br />Sq. Ft. Garage; <br /> <br />Sq, Ft, 2nd Floor; <br /> <br />Other: <br /> <br />Mobile Home: <br /> <br />Width: <br /> <br />Length: <br /> <br />Water Supply: <br /> <br />Proposed Septic Installation; <br /> Previous Site Evaluation Cf: <br /> <br /> Type of System: <br /> Test Holes Ready; <br /> Will ceil when holes ready: <br /> <br />Existing Septic Syetem: <br /> Existing Tank Size: <br /> Existing Drelnfleld Length: <br /> Type of System: <br /> Date Tank Pumped: <br /> <br />Valuation; <br /> <br />$ <br /> <br /> ) Other ....... ¢.~ ~ <br /> ~) ' agree to, build ao¢ordin9 to ~.~bmitted plans and sp~fic~tirns./t/he laws of <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT,: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Bidg, 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 />Investigation Fee; <br />Ci~ Fee: <br /> <br />TOTAL FEE: <br />RECEIPT NO.: <br /> <br />35.00 <br /> <br />--~- <br /> 5.00 <br /> <br /> 3.50 <br />114.21 <br /> <br /> <br />