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Received a~'" ~'y_.Y~,, : ~ MARION COUNTY BUILDING INSPECTION <br /> , ' ' '7~ = ~ IL~ h !. Senator BIug,, NO,, 225 <br />ZOning V~/,idation ~ v ~ <br /> <br /> city~Setba_ck Re~quiremec~ts <br /> <br /> Front <br /> Rear <br /> 220 High Street NE / ~ __ <br /> <br />Date I/.~_ -~ / ~ ~.. ) ~alem, Or.on 97301 , ~ --7 ~ <br /> P~one 588-5147 ~ Side ~ Side <br /> <br /> BUILDING ~ MO~iL~ HOME PTIC ERMIT APPLICATION <br /> <br />Job Address <br /> <br />Phone <br /> <br /> Mailing Address, <br /> <br />Site No <br /> <br />Property Tax Lot No,;: <br /> <br />Subdivision <br /> <br />Lot <br /> <br />Mobile Home Park:: <br /> <br />Lot Width Acres:: <br /> <br />Sp '~ <br /> <br />Zone <br /> <br />Irreg Lot:: <br /> <br />Cross Street <br /> <br />Block <br /> <br />Total I,* Spaces <br /> <br /> C~ni'r-actor Business Name and No <br /> <br />IArc'l~,t~-ctdEngineer <br /> <br />Phone <br /> <br />New [~ Addition L~ Demo;: <br />Alter D Relocation [~ Ccc Chg:: <br /> <br />Mobile Home <br />Width ~_~ <br /> <br />No Stories <br /> <br />Mobile Home <br />Length:: 4_~_~' <br /> <br />Sq Ft Main Floor <br /> <br />Sq Ft ~nd Floor <br /> <br />Proposed Septic Installation <br /> Previous Site Evaluation #' <br /> Type of System <br /> Will ca~l when holes ready' Prop;;ed Bed;o;rn; ,3' <br /> <br />Existing Septic System <br /> Existing Tank Size '7 ~' <br /> Existing Orainfield Length:; <br /> <br />Type of System <br /> <br />, Date Tank Pumped /--/~/- ,~ Existing Bedrooms /' <br /> )¢~1 have road this ap¢catton 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 ena property I own er occupy <br /> I am e registered builder OR ( ) the authorized representative ¢ a registered <br /> builder <br /> The work wdl be performed by a registered builder <br /> Other <br /> <br />agree to build according to the submiSed plans and specifications the laws of ~ <br /> <br />OTHER PERMITS REQI~{I~D BY THIS DEPT.: P~' <br />MC <br />Rev 12/87 <br /> <br />Sq Ft Garage:: <br /> <br />Occupant Load <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 />DEe Surcharge:: <br />Technical Review Fee <br />Reinspection Fee <br />Investigation Fee <br />City Fee <br /> <br />TOTAL FEE <br />RECEIPT NO <br /> <br /> coMRES Fl~ <br />Other <br /> <br />Water Supply <br /> <br /> <br />