Laserfiche WebLink
Re,~elved By:: _~=~' <br /> <br /> BUILDING [] <br /> <br />Subdivision <br /> <br />Section:: L~ J l-Town s hi~'~,~ <br />Lot Width ILot Depth <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> Senator Bidg,, No, 225 <br /> 220 High Street NE <br /> Salem= Oregon 97301 <br /> <br /> Phone $88-5147 <br /> Code-A-Phone 4:$0 P,M, - 8::00 AM. <br /> MOBILE HOME [] SEPTIC [~ PERMIT APPUCATION <br /> Mailing Address:: <br /> <br />Range~ <br /> ~,, <br />Acres <br /> <br />I itY- _Setback Requirements 1 <br />rent ~ Rear ~,~'~' <br />eCl .... <br /> ida ~ I Side <br />I" .7:_-_: <br /> <br />Site NO Cross Street:: <br /> <br />Lot <br /> 4 <br /> <br />Tax Lot NO Fleet SIC Zone <br /> <br />@p # Total # Spaces <br /> <br />Zone <br /> <br />Map:: <br /> <br />Corner <br /> <br />Irreg Lot <br /> <br />.Architect/Engineer:: ' <br /> <br />Contractor Business Name and NO:: <br /> <br />Phone <br /> <br />Phone <br /> <br />Address <br />Address <br /> <br />Type of Permit New:: L~ Addition [] Demo [~ Tach Use of Building <br /> ..~,~. T/~t Alter [] Relocation [] Oeo Chg [] Review L~ <br /> <br />Height of Building' Sq Ft Garage:: <br /> <br /> Mobile Home <br />.width /D' <br /> <br /> NO Stories Sq Ft Main Floor <br /> <br />~ MobileLength::Home,~¢,~. t : # Bedrooms~ <br /> <br />Proposed Septic Installation <br /> Previous Site Evaluation # <br /> Type of System <br /> <br />~q Ft and Floor <br />Occupa~ <br /> <br />Occupant Load <br /> <br />Other <br /> <br />Water Supply <br /> <br /> $. <br /> <br />Test Holes Re~¢y:_ <br />Will call when holes read~/_. <br /> <br />Proposed Bedrooms <br /> <br />Existing Septic System <br />Ex!~!!ng Tank Size <br />Existing Drainfield Length <br />Type of System:: <br />Date Tank Pumped:; Existing Bedrooms:: <br /> <br />I have read this appfication in its entirety and certify that tse stated information ia <br />Iruo and correct to the best of my knowledge <br />I am performing work on a property I own or occupy <br /> <br />Other <br /> <br /> M TS REQUIRED BY THIS DEPT,; PI. UMBING, MECHANICAL, ELECTRICAl <br /> <br />Valuation <br /> <br />Bldg 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 />OEQ Surcharge <br />Technical Review Fee <br />Reinspection Fee:: <br />Investigation Fee <br />City Fee:: <br /> <br />TOTAL FEE <br />RECEIPT NO <br /> <br /> <br />