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Received By: _..~ <br />City -" <br />Zoning.. Valid~~ <br />Date: <br /> Code'A4°hone 4:S0 P.M. - e:oo A,M. <br /> BUILDING ~MOBILE HOME [] SEPTIC [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br />Senator ~ld~, No, 22e- <br />220 High Street NE <br /> Salem, O~gon 97301 <br /> <br /> Phone 588~147 <br /> <br />ICity Setback Requir~.~t.s_i <br /> <br /> Side; irSide: <br /> <br />PERMIT APPLICATION <br /> <br /> ~¢ ~~ Site No,: Cross¢Street; / "] <br /> O~' ~,_ CC- ff~~ Property T~ Lot No.; FleetS/OZone; <br />Subdivision; Lotr <br /> <br />Mobile Home Park'. Sp. ¢: Total ¢ Spaces; <br /> <br />Let Wldth; <br /> <br />Township; Range: <br />to <br />Lot Depth: Acres: <br /> <br />Zoee; <br /> <br />Irreg. Lot: <br /> <br />Map: <br /> <br />Contra6tor Business ~ and o.; <br /> <br /> f~ New: [] Addition; [~ Demo: [] Tach. Use of Building; .. [ RES'"'-~ <br /> ~ Alter: Relocation; Fq Doc. Chg,; ~ Review: [] '.: ; COM [~ <br />~~ .No. Stories; <br /> <br /> Ft: Main Floc'r; .~ Sq.~ <br /> · ~i~'J Occupancy; <br /> <br />Mobile Home <br />Width: <br /> <br />Mobile Home <br />Length: ~ <br /> <br />Propc(~ed Septic Installation; <br />Previous Site Evaluation <br /> <br />Type of System; <br />Test Holes Ready: <br /> <br />Will call when holes ready; <br /> <br />Existing Septic System: <br />Existing Tank Size: <br /> <br /> Existin~_Dra. infiel8 Length: <br />__Type ,¢.-S'~tem ,. <br /> Da{~ Tank Pumped: <br /> <br />...... P~posed Bedrooms <br /> <br />Exist in~g.,,,Sed rod m s; <br /> <br />-Sq: Dr, Garage:' <br />Occ~pam Load: <br /> <br />Valuation; <br /> <br /> ) Other _ <br />._.~f~greo to build according to the 8u.t~rm~JtY4~ s arid sl3eoifications, the laws of <br /> <br /> OTHER PERMITS REQUIRED BY THIS DEP[: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Mobile Home Fee; <br /> <br />Zoning Surcharge: <br /> <br />State Surcharge: , <br /> <br />Site Evaluation Fee: .......... <br />Septic Permit Fee: <br />BEQ Surcharge; <br /> <br />Investigation Fee; ~ __ <br />City Fee: <br /> <br /> <br />