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City <br /> Valid ation/~~./~L~ \\9_ \'' ' ., '.?~,ator220 HIghBldg'street NO. NE22~ <br />Zoning <br /> <br />INSPECTION <br /> <br />City Setback Requirements; <br /> <br />,eft <br />Side: Z-/ <br /> <br /> . r~ ~,,~.~ ~%~e.A. p hone4 =30 ~tM__ S =SSPhorle SS~-] 147 A.M. <br /> BUILDING M~.,,t~HO~E ~ SEPTIC ~ PERMIT APPLICATION <br />Probity Owner; ~ __ ~ Phone; Address; <br /> <br /> Property Tax Lot No.: Fleet SIC Zone: <br /> ........ , ......... O-- <br />Subdivision'. ,, Lob <br /> <br />Se~ion; Township: ' Zone: <br /> <br />Lot Width: Lot Depth; <br /> <br />Aore~; .¢ Irreg. Lot: Corner: <br /> <br />Coptracto~r Bus)ne~¢ Name ~l~[~llll--IT....... ~ll~ I Add~:,~ ~ ~~ <br />ArChitect/Engineer: ~'"'-I Phone: / '~' -~4- <br />Type of Permit: Ne~-~7':: Addition: [] <br /> ~ Relooatlon; ~ <br /> <br />Demo: L~ Tach, <br />Oeo, Chg,: [~ Review; <br /> <br /> Alter; <br /> <br />Height of Building; <br /> <br />Use of Building: <br /> <br />Mobile Home <br />Length; ~--- <br /> <br />Occupancy: <br /> <br />RES <br /> <br />COM [] <br /> <br /> No, Stories: Sq, Ft, Main Floor: Sq. Ft. 2nd Floor: Sq, Fb Garage: Other: <br /> <br />MObile Home Occupa.t Lo~d: <br />Width: .... <br /> <br />Proposed Septic Installation; . <br />Type of System: -~X,~.)(~, ____. <br />Test Holes Ready: <br />WiJ__l .~al!,L'~/hen holes reatty; Proposed Bedrooms: <br />Existing Septic System: <br />Existing Tan_k.. Size; <br /> <br />Existing Drainfield Length: <br /> <br />Existing Bedrooms: <br /> <br />Type of System: <br />Date Tank Pumped; <br /> <br />Valuation: <br /> <br />Bldg. Fee: <br /> <br />Mobile Home Fee: <br />Fleet Surcharge: <br />Zoning Surcharge: <br />State Surcharger <br />Plans Cheek Fee; <br />Site Evaluation Fee; <br />Septic P~rmlt Fee: <br />DEQ Surcharge; <br />Technical Review Fee: <br />Reinspectlon Fee; <br />investigation Fee: <br />City Fee; <br /> <br />TOTAL FEE; <br /> <br /> the state of Oregon and the ordinapces of M&rion County. <br /> <br />S~GNATURE <br /> <br />OTfl~R PEI:IMIT~i REqUiReD B~ THIS D~P~ ~L~I~, ~EC~ICAL, ELECTRICAL <br /> <br /> <br />