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Received By ~' ',.~,'! ~'' ~ 'MARION COUNTcY BUILDING iNSPECTION J ~it~ _S_etback Requirements <br />City ~/',,-, ~,/ ~ '~ , ~ S~etor C-leg,, No, 225 ~eft Right <br />Zoning Validatio~ ~ ' :.. :~ 220 High Stre~ NE Front Roar <br /> <br />Dee ___~ ~ ~ ..... ~ r,~ ;-,-'V Phone 588-5147 Side:: _ Sde ..... <br /> ' . ',~ ~ ~Zd'~A-~hone 4::30 R,M,- 8:00 A,=/ <br /> BUILDING~ MOBILE HOME ~ SEPTIC~ PERMIT APPLICATION <br /> Property Owner:: _ ~ ~ Phone: '-- - '~ MAihn9 ~dress' <br /> <br /> Job Address Site NO Cross Street <br /> <br />Subdivision <br /> <br />Mobile Homo Park:: <br /> <br />Section/ ,¢,,._ Township Z// ~' <br />Lot Width Lot Depth <br /> <br />Property Tax Lot No <br /> <br />Lot <br /> <br />Range:: <br /> <br /> Sp # <br /> <br />[~oni <br /> I rreg ,C ,<t_ .......... <br /> <br />Aores <br /> <br />Map <br /> <br />Fleet S¢C Zone <br /> <br /> Contractor Business Name and No <br /> <br />_A~E~ <br /> <br />· Phone <br /> Phone <br /> <br />Address:: <br /> <br />Address <br /> <br /> Type of Permit l' New:: [~ Addition ~ Demo <br />..~E~-:~>i_~ (~.~ ~- ~"~.~e r :: [ I_ ' Relocation Fq CCC Chg <br /> <br /> No Stories;: <br /> Height of Building Sq Ft Main Floor <br /> <br /> Mobile Home I Mobile Home # Bedrooms:: <br /> Width I Length, <br /> <br />Proposed Septic Installation:: <br />Previous Sito Evaluation # <br /> <br />Type of System;: <br /> <br />TeSt Holes Ready <br /> <br />Will call when hole~,,,'oady <br />Existing Septic System <br />Existing Tank Size <br /> <br />__E_xi_sting Drainfield Length <br /> <br />Proposed Bedrooms <br /> <br />Type of System <br /> <br />___Date Tank Pumped <br /> <br />Existin_g_B_e~ rooms <br /> <br />( y ) I have read this application in its entirety and certify that the stated information is true and correct to the best of my knowledge <br /> I am perform{ng work on a property I own or occupy <br /> I am a registered builder OR ( ) the authorized representative of a regislered <br /> builder <br /> TIle work wffl be performed by a registered builder <br /> Other <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT,: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />d ........ -'reck- ....... -Us--~-~,t ~diiding ....... RES ~- <br />~ Review F~ /"~ ~ t,,.~v~-~ COM IJ <br /> <br /> Sq Ft 2nd Floor Sq Ft Garage Other <br /> <br /> ~ccupan~:: 0C'~'u~ent Load Water Supply <br /> <br />Valuation $ <br /> <br />Bldg Fee $ <br />Mobile Home Foe .... <br /> <br />Septic Permit Fee <br />DEQ Surcharge __ <br /> <br />TOTAL FEE <br /> <br /> <br />