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R.ceived Sy ~4~_,_~ NIAR,O. Ct~.~.U~_Ty IBU,LDING INSPECTION <br />ZOning V~lidation ~ *~ 220 High ~treet NE <br /> Salem, Oregon 97301 <br /> <br /> F~T~A-Phone 4:30 PM - 8;;00 AM <br /> <br /> Prepay Owner. -- <br /> <br /> i City Setb_ac__k R_eq?remen__ts- <br /> Front:: ~..~' 'R~.r <br /> Left <br />  Side R~t "- <br />PERMIT APPLICATION <br /> <br />Job Address:: <br /> <br />Sub_division <br /> <br />Mobile Home Park <br /> <br />Lot Width / Lot Depth Acres <br /> <br />Site NO <br /> <br />P~p~erty Tax Lot No <br /> <br />'Sp # <br /> <br />Zo~,~ Map <br />,rreg/~ C,~ <br /> <br />Cross Street , <br /> <br />Fle~t--S 'C 'Zone <br />Block ~:~ <br /> <br />Total ~/ Spaces <br /> <br />Phone <br /> <br />Mobile Home Occupancy:: <br />Width <br /> <br />Ty p~-~-~-~nit New ~ Addition:: [~ Demo ~ Tech <br />¢~;¢/~,/,f~/~/''' Alter ~ Relocation ~ Ccc Ch9:: ~ Review <br /> <br /> Height of Building No~tories Sq Ft Main Floor Sq-Ft 2nd Floor <br /> /¢ ~obile Home ¢ "~e~ms:: <br /> Length <br /> <br />Uae of Building RES ~ <br /> COM : <br /> <br />Sq Ft Garage Other <br />Occupant Load <br /> <br />Proposed Septic Inatal[ation <br />Previous Site Evaluation <br /> <br />:type of ~ystem <br />Test Holes Re~dy <br /> <br />Will ca!l when holes ready <br /> <br />Proposed Bedrooms <br /> <br />Existing Septic System <br /> Existing Tank Size <br /> Existing Drainfield Length <br /> <br />Type of System:: <br /> <br />Date Tank Pumped <br /> <br />Ex~sting Bedrooms:: <br /> <br />SIGNATURE OF APPt. _~b_ _~ . <br />OTHER PERMITB REQUIRED ElY THIB DEPT,:: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br /> ~ater 9pply <br /> <br />Valuation .... <br />Bldg Fee $-- ~'~- ' -'~"~ <br />Mobile Home Fee <br />Fleet Surcharge <br />Zoning Surcharge <br /> .... <br />Stats Surcharge:: __._ <br /> <br />Site Evaluation Fee:: __. <br />Septic Permit Fee:: <br />DEQ Surcharge ............. <br />Technical Review Fee <br />Reinapsction Fee <br />Investigation Fee . <br />City Fee <br /> <br />BECE, T NO <br /> <br /> <br />