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· SalC, m~ Oregon 97301 L~tt Right <br /> <br />~t[-U ~-~ I~f..J'~L~INO [] MOBILE HOME [] SEPTIC [] PERMIT APPLICATION <br /> <br />Property Owner <br /> <br />Job Address <br /> <br />Subdivision <br /> <br />Mobile Home Park <br /> <br />~¢ti n Township ~ <br />LOt Width ' [_L.o_t Dap'th ...... <br /> <br />Phone;; I Mailing Address <br /> <br /> Site NO :: Cross Street <br /> <br />Property Tax Lot No <br /> <br />Lot <br /> <br />Sp CZ <br /> <br />A Corner <br /> <br />Fleet S/C Zone <br /> <br />Block <br /> <br />Total # Spaces <br /> <br />'type o;r ,ge.~m'~-[ <br />Height of Build~ <br />Width <br /> <br />New <br />Alte~ LJ Relocation II Occ Chg L_ Review:: [] <br /> <br /> AddressA~dress <br /> Address:: .~,,,2,~,~2, <br /> <br />Addition L~ Demo ~ Tach <br /> <br />Mobile Home <br />Length:: <br /> <br />Sq Ft Main Floor <br /> <br />Sq Ft 2nd Floor <br /> <br />Use of Building RES [~ <br /> COM [] <br /> <br />Sq ¢t Garage Other <br /> <br />Bedrooms <br /> <br />Occupancy <br /> <br />Occupant Load <br /> <br />Proposed Septic Installation:: <br />Previous Site Evaluation <br />Type of System <br />Test Holes Ready <br />Will call whorl holes ready Proposed Bedrooms <br />ExiSting Septic System <br />Existing Tank Size <br />~xisting Dramfield Length <br />Type of System <br />Date Tank Pumped Existing Bedrooms <br /> <br /> ) I have read this application in its oof~roty and cortify that tho statod information is <br /> true and correct to the best of my knowledge <br /> <br /> builder <br /> <br />S~GNATLJRE OF APPLICANT _~_ ~'~'~"~ ~ <br />OTHER PERMITS REQUIRED BY THIS DEPT: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Bldg Fee <br /> <br />Mobile Home Fee <br />Fleet Surcharge <br />Zoning Surcharge <br />State Surcharge <br />Plans Che6k Fee <br />Site Evaluation Fee <br />Septic Permit Fao:: <br />DEQ Surcharge <br />Technical Reviow Fao <br />Reinspection Fee <br />Investigation Fee <br />Cily Fee <br /> <br />TOTAL FEE <br />RECEIPT NO <br /> <br /> <br />