Laserfiche WebLink
Rece~ve~J <br /> By <br /> ~- ,~:~.,~v_~_*'4z/~ ,- MARION COUNTY BUILDING INSPECTION <br /> <br />Zoning Validation ~ I; ,i x , $~eat~l-'~'~g No. 22~ <br /> ~. ~0 ~gh,Stre~ NE <br /> <br /> BUILDING ~MOBILEi,HOMEi:~ SEPTIC ~ PERMIT APPLICATION <br /> Property Owner - <br /> <br />Job Address <br /> <br />Front:: ~ Rear <br /> <br />Left ¢' Right <br />Side:: ~- <br /> <br /> IMp, iling A.t;jdress ~ _ /I , ,, ,. ~ <br />Site No -~oss Street ' -- <br /> <br />S~bdivision :: <br /> <br />Mobile Home Park <br /> <br />Property Tax Lot No:: <br /> <br />Lot:: <br /> <br />Sp ,,¢:: <br /> <br />Block <br /> <br />Total /t Spaces <br /> <br />Section Township <br />Lot Width Lot Depth <br /> <br />Map <br /> <br />Type of Permit ] New ~ Addition <br /> <br /> N~) <br /> St_eeo;. .... <br />Height of Building Sq Ft Main Floor <br /> /~/ Mobile- F~ome Bedrooms:: <br />WidthM°bile Home Length # <br /> <br />Demo [] Tach <br />Ccc Chg [~ Review <br /> <br />Proposed Septic Installation <br />Previous Site Evaluation ,-¢ <br /> <br />Type of ~y~_te? , <br />Test Holes Ready <br /> <br />Will call when holes ready <br />Existing Septic System <br />Existing Tank Size <br /> <br />Ex,sung Drainfieid Length <br /> <br />Proposed Bedrooms <br /> <br />Type of System:: <br /> <br />Date Tank Pumped:: <br /> <br />Existing Bedrooms <br /> <br />I ba~e re~d this application in its entirety and certify that the stated mtormat~on i$ <br />true and correct to 1he best of my knowlodgo <br />I ~nl podormlng work on a property I own or occupy <br />I am a registered builder OR ( r the authorized reprosontativo of a registered <br />builder <br />The work wll~ be perfortT~ed by a rogistefed builder <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT,: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Roy 12/87 <br /> <br />Use of Building I RES <br /> <br />Sq Ft Garage Other <br />Occupant Load <br /> <br /> Valuation <br /> <br /> BIdg Fee <br /> <br /> Mobile Home Fee <br /> Fleet Surcharge <br /> Zoning Sur0harge <br /> State Surcharge <br /> Plans Cheek Fee <br /> Site Evaluation Fee <br /> Septic Permit Fee <br /> DEQ Surcharge <br /> Technical Review Fee <br /> Reinspection Fee <br /> Investigation Fee <br /> City Fee <br /> <br />TOTAL FEE <br />-RECEIPT NO <br /> <br />Sq Ft 2nd Floor:: <br />Occupancy <br /> <br />/¢¢,, 5-4 <br /> <br /> .... <br /> ..... <br /> <br /> ¢. <br /> <br /> <br />