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City ¢'~*~¢¢¢,,~ Senator Bldg,, No,, 225 <br />Zoning Validation .~v ~.~ .~ 220 High Street NE <br /> Salem, Oregon 973~ <br /> <br /> BUILDING ~ <br /> <br />Cit~y _Setback _R. eq~reme~nts <br />Front:: ~ / Rear <br />Left - / ~ Right <br />Side ~.~ ~ Side <br /> <br />MOBILE HOME [] SEPTIC [] PERMIT APPLICATION <br /> <br />Phone:: <br /> <br /> Site N° ::77~ <br /> Property Tax Lot NO:: <br /> <br />Job Address <br /> <br />Mailing Address:: . <br /> <br />Cros Str ,et <br /> <br />Fleet $/c Zone:: <br /> <br /> Lot Block:: <br />Mobile Home Park;: Sp #:: Total ¢ Spaces <br /> <br />Lot Wid.~:~_ s <br /> <br />Lot Depth:: ........ Acres: <br /> z_L <br /> <br />Zone:~ ~'~, Map <br />Irr,~Ot:: Corner:/~ <br /> <br />Contractor Business Name and No ~ <br />ArChitect/Engineer - ~ <br /> <br />Phone <br /> <br />Phone <br /> <br /> Type of Permit ~ew - [~..."~'"' Addition [] Demo [] Tach <br />~/~/~'~//.~//~t/,/IAlter:: [~ Relocation [] Ccc Chg [] Review [] <br /> <br /> Ft Main F o :: 2nd Floor:: <br /> Height of/~Building/ Sq,/,~ ~,¢~ ~r Sq Ft ,-- <br /> <br />NO Stories <br /> / <br /> <br />Mobile Home Mobile Home # Bedrooms Occupancy:: <br />Width Length ~ <br /> <br />Use of Building 7~[-S- <br /> r IcoM [] <br />Sq Ft Gara e Other' <br /> <br />Occupant Lead W~..?ply <br /> Va,.at,on /,. <br /> <br />Proposed Septic Installation:: <br />Previous Site Evaluation ~¢ <br /> <br />___Ty~,.,.e of System <br /> Test Holes Ready <br /> <br />Will call when holes ready:; Proposed Bedrooms <br /> <br />Existing Septic System <br /> Existing Tank Size <br /> Existing Drainfield Length:: <br /> <br />Typ_e_o!_~ystem ;: <br /> <br />Date Tank P~_mped:; <br /> <br />Existin9 Bedrooms <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev 12,87 <br /> <br />Etdg Fee <br /> <br />Mobile Home Fee:: <br /> <br />Fleet Surcharge:: <br /> <br />Zoning Surcharge:: <br /> <br />State Surcharge <br /> <br />Plans Check Fee <br /> <br />_L/S_ ¢ <br /> <br />Site Evaluation Fee <br /> <br />Septic Permit Fee <br />DEQ Surcharge <br />Technical Review Fee <br />Reinspection Fee <br />Investigation <br /> <br />City Fee <br /> <br />TOTAL FEE <br />RECEIPT NO <br /> <br /> <br />