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O~te; <br /> ,/,~ ~:~(:~ ~0~ Phone 588-5147 <br /> <br /> EE~ <br /> <br /> City Setback Rec[uirements:_ <br /> <br /> ~ L Side~ g/- <br />PERMIT APPLICATION /z~ ~.~,>,,~.-~_e, .c. <br /> <br /> Job Ad4:Bess; , '. ~_ ~.~,~-. <br /> 3 '.,6.4_:-. FY, . h!-. <br /> ! :: <br /> <br /> Mobilp Homo ~ark; ~%--- ':/' c~'~ _... <br /> <br /> T~nshipt · / Range: · <br /> <br />...... ~:" 'i · <br /> <br />Site No,; <br /> <br />Cross Street: <br /> <br /> Fleet SIC Zone: <br />.~lock,!.,-,,, r-I <br /> <br /> Total # Spaces; ,,,' <br /> <br />Irreg. Lot: <br /> <br />r;~p; .... <br />c~rn22L; .... <br /> <br />Contractor Business Name and No.; <br /> <br />Architect/Engineer: <br /> <br />Phone: <br /> <br />Address: <br /> <br />Address: <br /> <br /> Ty. pe~f Permit; I New: ~,~" Addition; [] Demo: [] Tach, <br />.~:~ Alter; [] Relocation: [] Ccc. Chg.: [] Review; [] <br /> <br />MobileHeight Of HomeBUilding; MobileLength;N°' StorieS;Home_ _ ,/ISg'Bedrooms;Pt' Main Floor: ' Occupancy~Sq' Ft. ~2nd Floor: <br />Width; ~ <br /> <br />Use of Building: <br /> <br />Sq, Ft, Garage; <br />Occupant Load: <br /> <br />Valuation: <br /> <br />, Proposed Sag lc Installation: <br /> Previous Site Evaluation ¢: <br /> Type of ,System; <br /> <br />Test Holes Ready; <br />Will call when holes ready: Proposed Bedrooms: <br />Existing Septic System; <br />Existing Tank Size', <br /> <br />Existin9 Drainfield Length: <br />Type of System; <br /> <br />Date Tank Pumped: Existing Bedrooms; <br /> <br /> builder, <br /> <br /> Other .~'~. <br /> <br />.81GNATUR~*OP APPLICANT: ...... - -..~[5 City Fee: <br />/OTHER PERMmTS REQUIRED BY T~IS ~PT.: PL~M~IN~,, F. ~an ~a~ ~TAL FEE; <br /> <br /> ;, .- ~ ' ' · /Ii w.s, L n, OR 97068 RECEIPT NO,; <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 />DEQ Surcharge: <br />Technical Review Fee: <br /> <br /> ~ / <br /> RES <br /> <br /> COM [] <br /> <br />I Other: <br /> ........... <br /> <br /> Water ~Ul~ply~ <br /> <br /> $ ~ <br /> <br /> $. <br /> <br /> <br />