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Z~onino Vali~'t~_cjr~.. ~ 0 1388 <br /> <br />BUILDING INS?EC'ftON <br /> BUILDING [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> MOBILE HOME [] SEPTIC [] <br /> <br /> I City Setback Requirements: <br /> <br /> Front; Rear; <br /> Left RJghi" <br /> Side: S de; <br /> <br />PERMIT APPLICATION <br /> <br />Property Owner: X / Phone: <br />'" Job A~dre'~s: "~ '~ <br /> <br />Subdivision <br /> <br /> Mailing Address: <br /> <br />Site NO.: <br /> <br />Property Tax Lot No.: <br /> <br />Lot; <br /> <br />Mobile Home Park: Sp. #; <br /> <br />Section: '~ Township: ,, I Range: <br />Ix, /~ /x z/.$ IX. / <br />Lot Wiath'. Lot Depth: .. Acres:' <br /> <br />Zone; Map: ~ <br />Irreg, Lot: Corner; <br /> <br />Fleet SIC Zone; <br />Total # Spaces: <br /> <br />Contractor Business Name and No.: Phone: Address: <br />Architect/Engineer; Phone: Address; <br /> <br />Type of Permit: New: [] Addition: [] Demo: ~ Tach, Use of Building: <br /> <br /> Alter: [] Relocation: [~ gcc, Chg,; [~ Review: [] <br /> <br />Height of Building; No. Stories: Sq. Ft. Main Floor: Sq, Ft, Garage; <br /> <br />Moblle Home ¢~ Bedrooms: Occupant Load: <br />Width; <br /> <br />Mobile Home <br />Length: <br /> <br />Sq. Ft. 2nd Floor: <br />Occupancy: <br /> <br />Valuation: <br /> <br />Proposed Septic Insteliatlon: <br />Previous Site Evaluation #; <br />_.__~.p_e, of ~ystem; <br />Test Holes Ready; <br />Will call when holes ready; Proposed Bedrooms; <br />Existing Septic System: <br />Existing Tank Size: <br />Existing Drainfield Length; <br /> <br /> Type of System: / ! . <br />>~,Date Tank Pumped; "~/~ ~ )~ Existing Bedrooms; <br /> <br /> I have read this application In Its entirety and certify that the stated information Is <br /> true and correct to the best of my knowledge. <br /> I am performing work on a prope~'y I own or OGGUpy, <br /> I am a registered builder OR ( ) the authorized representative of a registered <br /> builder. <br /> The work will be performed by a registered builde~ <br /> Other <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT,: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br /> RES [] <br /> COM ~ <br /> <br />Other; <br /> <br />Water Supply: <br /> <br />SIdg. 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 />Relnspection Fee; <br />investigation Fee; <br />City Fee'. <br /> <br />TOTAL FEE; <br />RECEIPT NO.: <br /> <br />$ <br /> <br />$ <br /> <br /> <br />