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Receivedey ~ ~ ~L,~- <br />City <br />Zoning Validation <br /> <br />BUILDING <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> Senator 81dC,, NO, 225 <br /> <br /> MOBILE HOME [] SEPTIC [] <br /> <br />City Setback Re.q_uireme~nts <br /> <br />Left ~'~-/ ~ Right <br />Side ~ ~ Side <br /> <br />PERMIT APPLICATION <br /> <br />Prope[~ Owner:: <br /> <br />Job Address <br /> <br /> Subdivision <br /> <br />~ Home Park <br /> <br />Site No:: <br /> <br />Property Tax Lot No" <br /> <br /> Cross Street:: ~ <br /> Fleet S~C Zo~e <br />Lot:: Blo0k <br /> Total ¢ Spaces <br /> <br />Sp, +¢ <br /> <br />Lot Width' I Lot 0epth;; <br />..... I I/o ' <br /> <br />IE~nge" <br />Acres <br /> <br />Zone Map. <br />Irreg Lot <br /> <br />Ii -o~i~aoi0r Business Name en~ No:: <br /> rchitect E gee , <br /> <br />Phone <br /> <br />Phone:: <br /> <br />I <br />L_Address <br /> <br />Type of Permit [ New ~ Addition [] Demo:: [] Tach <br />//~'~ 7L ALter ~ Re[ocatior~ [] Ccc Chg ~ Review <br /> <br /> Height of Building / No Storie~:: Sq Ft Main FIO~ Sq Ft 2nd Floor <br /> <br />~1~ Home Mobile Home - ~ Bedrooms Occupancy <br />Width Length ~ <br /> <br />-' Use of Building ! RES <br /> <br /> ~'q Ft Garage Other <br /> x/s7 ' <br /> Occupant Load Water Supply <br /> <br /> Valuation ~ ~ ¢¢ ¢~ <br /> <br />Proposed Septic installation:: <br />Previous Site Evaluation # <br /> <br />Type of System <br /> <br />Test HeWs Ready <br /> <br />Will call when holes ready <br /> <br />Existing Septic System <br />Ex~s_tin_g Tank Size <br /> <br />--Proposed Sedrooms:: <br /> <br />Existing Dralnfield Length <br /> <br />Type of System <br />Date Tank Pumped <br /> <br />Existing 0edroom~ <br /> <br /> Mobile Home Fee <br /> <br />State Surcharge ~,~7 ~/,~ <br />Plan* Cheek Fee ~_~ ~: ,. <br />Site Evaluation Fee <br />Septic Permit Fee <br />DEQ Surcharge <br />Technical Review Fee <br />~Reinspection Fee <br />investigation Fee <br /> <br /> <br />