Laserfiche WebLink
Received By; <br /> <br />City Vahdas~n <br />Zoning ' ' : <br /> <br />Date: <br /> <br />BUILDING [] <br /> <br />MARION COUNTY BUiLDiNG INSPECTION city Setback neq,?_e_ments~ <br /> Senator Bldg. No. 22S Right- <br /> 220 High Street NE Front: Rear; <br /> <br /> Salem, Omgoll 97'g01 Left <br /> Phone 588-5147 Side: I Side; <br /> CodcJ-A=PllOne S'$0 RI~I-g'OOA.M, ~ /'~¢' ~-~:,~S~ <br /> MOBILE HOME [] SEPTIC ,[~ PERMIT APPLICATION <br /> <br />Property Owner: <br /> <br />Job Address; <br /> /~/~ z <br /> <br />Subdivision: <br /> <br />Mobile Home Park: <br /> <br />Section; TOL~O~,n s hiPe~..,..% <br />Lot Width; , <br /> /7z <br /> <br />Phone: Mailing Address:,,~ ~ ~..~- <br /> Sfte No,; 'Cross StOeet'. <br /> <br /> Property T~ Lot No,; ~c~ ~ Fleet S/C Zone: <br /> <br /> Sp. ~: Total ~ Spies: <br /> <br />rreg, Lot: Corner: <br /> <br /> Jr)ese Name and <br />~l~ite~t~ <br /> <br />No.: Phone: Address: <br /> Phone; Address: <br /> <br />Type of Permit; New: [] Addition; ~ Demo: [~ Tach, Use of Building: RES [] <br /> Alter', LJ Relocation: [] Ocs. Chg.: [] Review; F~ COM r'l <br /> <br />Height Ct Building: NO. Stories; Sq. Ft. Main Floor; Sq, Ft, 2nd Floor: Sq. Ft. Garage; Other', <br /> <br />Mobile Home ! Mobile Home <br />Width; j Length: <br /> <br />,,¢ Bedrooms: <br /> <br />Occupancy; <br /> <br />Occupant Load: <br /> <br />Water Suppty; <br /> <br />Proposed Septic Installatlon; <br />Previous Site Evaluation #; <br />_~y.,~e of System: <br />Test Holes Ready: <br />· Will call when holes ready_: Proposed Bedrooms: <br /> <br />Existing Septic System: <br /> Existing Tank Size: .... <br /> Existing Drainf!.~ld Length <br /> Type. S, S~stem; ~ 0~ ~ ~ '~ <br /> Date Tank Pumped: ~/~ ?~ ~ Existing Bedrooms: <br /> <br />SJGN^TURE OF API~LIOAN'f, ,~'~ <br /> <br />OTHEFI ¢'ERMiT$ REOUIFIED BY THIS DEFY[: PLUMBINGi~ MECHANICAL, ELECTRICAl. <br /> <br />Bldg, Fee; $ <br />Mobile Home Fee: <br /> <br />Zoning Surcharge: <br /> <br />State Surcha~Je: <br /> <br />Plans Check Fee; <br /> <br />Site Evaluation Fee: <br /> <br />DEQ Surcharge: <br />Technical Review Fee: <br />Reinspectlon Fee; <br />Investigation Fee: <br />City Fee; <br /> <br />TOTAL FEE: <br />RECEIPT NO,: <br /> <br /> <br />