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Received By/'~'--~ ¢/ //,//~,. MARION COUNTY BUILDING INSPECTION <br /> <br /> . ' . ~/~' ~ ~ ~ * Salem O~gon 973~ <br /> <br /> Cod~A~e 4:30 PM - 8;;00 A,,M,, <br /> BUILDING ~ MOBtLE~HQ~E ~ SEPTIC ~ <br /> Proper~ O~e~ <br /> <br />etback R~equ,r _ements <br /> <br /> ~.~,g Rear <br />Left ---- ,. Right <br />[ ,5- Sid <br /> <br />PERMIT APPLICATION <br /> <br />Job Address <br /> <br /> division <br /> <br />Mobile Home ~k <br /> <br />SeCtiOn <br /> <br />LOt Width:: <br /> <br />Lot Depth:: Acres <br /> ¢5-/ <br /> <br />Site No:: <br /> <br />roperty Taxx Lot No:: <br /> <br />Cro,~s Street <br /> <br />Fleet S/C Zone <br /> <br /> Block <br /> <br />Sp · <br /> <br />ZO n ~:~ ~ Map <br /> <br />Irreg ~t:: Oorne~./~ <br /> <br />Total ¢,~ Spaces <br /> <br />Contractor Business Name and NO:: <br />Architect/Engineer .... <br /> <br /> Type of Permit J New ~ Addition:: [] Demo r~ Tach <br />6/~.~'/.~ O~'~,~ Alter LJ Relocation ~J Ccc Ohs [] Review F-1 <br /> / <br /> <br />Sq Ft Main Floor:: Sq Ft 2nd Floor:: <br /> Occupancy <br /> <br />//. Bedrooms <br /> <br />WidthM°bileHeight of Home*/¢!Building .....Length:;M°bileN° Stories::/Home <br /> <br />Proposed Septic Installation <br />Previous Site Evaluation <br /> <br />___Ty__~9 of 8~s,!em <br /> Test Holes Ready <br /> <br />Will call when holes ready Proposed Bedrooms <br />Existing Septic System:: <br />Existing Tank Size <br />Existing Drainfield Length <br />Type of System <br /> <br />Existing Bedrooms <br /> <br />Date Tsnk Pump_e_d:: <br /> <br />have read this application in its entirety and certify that the stated information ia <br />am a registered buitder OR t ) the authorized representative of a registered <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Re~ 12/8"/ <br /> <br />Use of Building RES <br /> COM <br /> <br /> Oth , <br /> <br />Occupant Load Wa~r ~upply <br />V~luation:: $~~ ~ <br />Bldg Fee $~ <br />Mobile Home Fee <br />Reel Surcharge <br /> <br /> State Surcharge /~, ~J <br /> Plans Check Fee /~¢. 2~ <br /> <br /> Site Evaluation Fee <br /> Septi~ Permit Fee <br /> OEO Surcharge;: <br /> Technical Review Fee <br /> Reinspeotion Fee <br /> I~veatigafion Dee:: <br /> <br /> TOTAL FEE <br /> <br /> *EOEIPT NO <br /> <br /> <br />