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Received By .............. <br /> <br />City <br />Zoning Validation <br /> <br />BUILDING [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br />Sel3ator Bldg. No. 22S <br />220 High Street NE <br /> Salem~ Oregon 97301 <br /> <br /> Phone 588-5147 <br /> Code-A-Phone 4:~$g F.M- - a:ss A.M. <br /> <br /> MOBILE HOME [] SEPTIC <br /> <br />Property Ov~:: ~ __ . ' Phc ;; <br /> <br />Job Addre~ / {,! ,~_ ~- Site No <br /> v 6064 Shaw Lane -:~-- <br /> <br />Subdivision <br /> <br />Mobile Home Park:: <br /> <br />Property Tax Lot No <br /> <br />Lot <br /> <br />Sp # <br /> <br />Zone <br /> <br />Irreg Lot:: <br /> <br /> Requirements <br />[ ;i;cYn~etba°k Rear <br /> <br /> Side Right <br /> Left ] Side_ <br /> <br />PERMIT APPLICATION <br /> <br />Fleet S/C Zone <br /> <br />Block <br /> <br />Total # Spaces <br /> <br />Map;:,,5;5~/,/ <br /> <br />Corner <br /> <br />Contractor Business Name end NO <br />Archit~0t iE r~gir~e~r-- ' <br /> <br />Phone <br /> <br />Phone <br /> <br />Address:: <br /> <br />Address <br /> <br />Type of Permit <br /> <br /> Repair <br /> <br />' -~-ei¥{ ~i e~'iid[~g <br /> <br />Mobile Home <br />Width <br /> <br />Alter:: [] Relocation:: [] <br /> <br />NO Stode'e::' <br /> <br />Mobile Home <br />Length <br /> <br />Demo [] Tach <br />Ccc Chg [] Review <br /> <br />Sq Ft 2nd Floor <br /> <br />Occupancy <br /> <br /> COM I <br /> <br />Sq ~i- Garage ........ ~--O~-er <br />Occupant Load ~ <br /> <br />Proposed Septic installation <br />Previous Site Evaluation ¢~ <br />Type of S~/stem:: <br />Test Holes Ready <br />Will call when holes ready:: Proposed Bedrooms <br />Existing Septic System <br />Existing Tank Size <br />Existing Drainfield Length <br /> <br /> Date Tank Pumped Exieting Bedroome <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 />DEQ Surcharge <br />Technical Review Fee <br />Reinspection Fee <br />Investigation Fee <br />City Fee <br /> <br />TOTAL FEE <br /> <br />75.00 <br />5,00 <br /> <br />80,00 <br /> <br />OTHER PERMITS REQUIRED BY THIS DEP'i': PLUMBING, MECHANICAL. ELECTRICAL <br /> <br /> <br />