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Received By;. <br /> <br />City <br />Zoning YalidatiorC ......... <br /> <br />BUILDING [] <br /> <br />MARION COUNTY BUILDING ~NSPECTION <br />Senator $1efj. NO. 225 <br />220 High.~treet NJ; <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 <br /> <br /> MOBILE HOME [] SEPTIC [] <br /> <br />I,Qity,,,,.S?back Requirements: <br /> <br /> Front; Rear: <br /> <br />~ Left Right <br />]Bide; , Bide: <br /> <br />PERMIT APPLICATION <br /> <br />-¢;~operty Owner: I.ce -- <br /> ~/ '~-(."4~ '4. E~ /.. J~'' P b~nf./'.~ <br /> ,4 <br /> Job Address: <br /> <br />Bubdivision; <br /> <br />Mobile Home Park: <br /> <br />Lot Width: Lot Depth: <br /> <br />tRange: ,~ ..) ..... <br /> <br />__ '~/~'~ ~ 1 Mailing Address: <br /> <br />Site NO,; Cross Street; <br /> <br />Property Tax Lot NO.: <br /> <br />Lot; <br /> <br />Sp, #: <br /> <br />Zon¢~-.). _ _3[ ~ Map%.~._~. / <br />Jrreg, Lot: Corner: <br /> <br />Fleet S/C Zone; <br /> <br />Block; <br /> <br />Total ~¢ Spa0es: <br /> <br />Phone; <br /> <br />Phone: <br /> <br />Address: <br /> <br />Address: <br /> <br />Type of Permit: I'-~W: E~ <br /> <br />Height of Building; <br /> <br />Mo6ii~ ........ <br />Width: <br /> <br />Addition: [] Demo: [] <br />Relocation: [] Ccc. Chg,; [] <br /> <br />NO. Stories: C Sq. Ft. Main Floor: ~ <br />LMeOn~t~:Home ~[ ~ ~s~- - ~L <br /> <br />Tach, <br /> <br />Review: [] <br /> <br />Sq. Ft. 2nd Floor: <br /> <br />Use of Building: <br /> <br />Sq, Pt, Garage; <br /> <br />RES <br /> <br />COM <br /> <br />Other: <br /> <br />Occupancy: Occupant Load: Water Supply; <br /> Valuation: $_ <br /> <br />Proposed Septic Installetlon; <br />Previous Site Evaluation ¢,~; <br /> <br />Type _o_f ~yStem; <br /> <br />Test Holes Ready: <br /> <br />Will call when holes reedy; <br />~xisting Septic System: <br />~E~jstieg Tank Size: <br /> <br />Existing Dreinfleid Length; <br /> <br />Proposed Bedrooms; <br /> <br />Tyj?~ of System: <br />Date Tank Pumped: <br /> <br />Existing Bedrooms: <br /> <br />OTHER PERMITS REQUIRED DY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRtCAL <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; <br />DEC Sumharge', <br />Technical Review Fee; <br />Reinspeetion Fee; <br />investigation Fee: <br />City Fee; <br /> <br />TOTAL FEE; <br />RECEIPT NO,: <br /> <br /> <br />