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COUNTY BUILDING INSPECTION <br /> Senator BIdg, NO, 225 <br /> 220 High Stree~ NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 <br /> <br />City Setback ReqL!irements <br />Frorlt:: Rear <br /> <br />Left RiQht <br />Side I S~de <br /> <br /> ! , =' ~,: ,~ Code-A-Phone 4:;30 RM. - 81:00 AM <br /> <br /> ' ~ Phone:: <br />Prop ROS~, Pe~e¢ ~ 3acquel ] e 678-5654 <br /> <br />Job Addrese:; <br /> <br />19065 Beaver Lane NE Aurora <br /> <br />Subdivision <br /> <br />Mobile Home Park <br /> <br />Site No <br /> <br />PERMIT APPLICATION <br /> <br />Mailing Address <br /> <br />Property Tax Lot NO <br /> <br />Lot:: <br /> <br /> Sp 1/ <br /> <br />i Township it Range; J -~one Map <br /> ~ kreg Lot Corner <br /> Lot Depth Acres <br /> <br />Cross Street <br /> <br />Fleet S/C Z~ne <br /> <br />Block <br /> <br />Total # Spaces <br /> <br />Section <br /> <br />Lot Width <br /> <br />Contractor Business Name end No Phone:: <br />Architect/Engineer Phone:; <br /> <br />Address ' <br /> <br />--T~pe of Permit l' N~--' U Add~iion [] Oemo <br /> / <br /> ~{¢ Shp Rej'l e~a~lter [] Relocation <br /> <br />-~e~ht of Building NO Stodes Sq Ft Main Froot <br /> <br /> Mobile Nome Mobile Nome # Bedrooms <br /> Width Length <br /> <br />Tach <br /> <br />Review:: [] <br /> <br />Sq Ft 2nd Floor <br /> <br />Occupancy <br /> <br />Use of Building <br /> <br />Sq Ft GarAge <br /> <br />Occupant Load <br /> <br />Valuation <br /> <br /> RES <br /> COM <br /> <br />Other~ <br /> <br />Water Supply <br /> <br /> Proposed Septic Installation <br /> Previous Site Evaluation #:: <br />_Type Of System:: <br /> <br />Test Holes Ready <br /> <br />Existing Septic System <br />Existing Tank Size <br /> <br />Existing Drainfield Length <br />Type, Of System <br /> <br />Date Tonk Pumped: 5 / ,~ 3 / 8 8 <br /> <br />~ro__pesed Bedroom...s <br /> <br />Exiatir'~9 Bedrooms <br /> <br />SIGNATURE OF APPLICANT ~,,/i~~. <br />OTHER PERMITS REQUIREI~' BY THIS DEI:~T,: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Bldg Fee <br /> <br />Mob,lo Home Fee <br />Fleet Surcharge <br />Zoning Surcharge <br />State Surcharge <br />Plans Check Fee <br />Site Evaluation Fee <br />Sopris Permit Fee <br />OEQ Surcharge <br />Technical Review Fee <br />Reinspeetion Fee:: <br />Investigation Fee <br />City Fee <br /> <br />TOTAL FEE <br />RECEIPT NO:: <br /> <br />60_ 0(3 <br /> <br />60.00 <br /> <br /> <br />