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MARION COUNTY BUILDING INSPECTION <br /> <br />Senator BidS,, No 22e <br />220 High ,~treet NE <br />Salem, Oregon 97301 <br /> <br /> BUILDING E~OBILE HOME [] SEPTIC [] PERMIT APPLICATION <br />l~ Phone IV~iliog- --AC, d r e ss :: ~ <br /> <br /> Site No CrosS2~ <br /> Property Tax L~ No ~ S¢C Z~ <br /> Lot Block <br /> Mobile Home ~rk ap, ¢ Total ¢ Spaces <br /> <br /> Section t Township:: <br /> Lot Width Lot Depth:: <br />. ?¢ /¢0' <br /> <br />Range -- Zo n¢~,~,~,~ Map <br />~/ffJ ]rreg,/~; Corner <br /> <br />Phone' <br /> <br />Phone <br /> <br />Address <br />Addressl: <br /> <br />/~ype of Permit <br /> <br />Height of Building:: <br /> <br />Mobila Home <br />Width <br /> <br />-- "~"' Addition' <br /> AFter fq Relocation <br /> <br />No Stories <br /> / <br /> <br />Mobile Home <br />Length:: <br /> <br />[] Demo <br /> <br />[] Occ Chg:: <br /> <br />Sq Ft Main Floor <br /> <br />Review' [] <br /> <br />Sq Ft 2nd Floor <br /> <br />-0s~ of Building <br /> <br /> Sq Ft Garage Other <br /> Occupant Load Wa~ply <br /> Ysluetion ' ~ <br /> <br /> eldg Fee $~, <br /> Mobile Home Fee <br /> Fleet Surcharge <br /> Zoning Surcharge <br /> State Surcharge:: <br /> <br /> StYe Evaluation Fee <br /> Se¢ic Permit Fee:: <br /> DEQ Suroharge <br /> TeChnical Reviow flee <br /> Reinspectio~ Fee <br /> Investigation Fee <br /> City Fee:: <br /> <br /> ~EGEIPT NO <br /> <br />Proposed Septic Installation <br />Previous Site Evaluation ¢~;: <br /> Type of System <br /> Test Holes Ready <br /> Will call when holes reedy <br /> <br />Existing Septic System <br />.... Existing Tank Size <br /> <br />p~'oposed Bedrooms:: <br /> <br />Existlq~ Drainfield L~,ngth <br />Type of System;: <br />Date Tank Pumped Existing Bedrooms <br /> <br />( ~')~ I have read ~his apptication in Its entirety and certify that the stated information Is <br /> <br />t ~/'~ am performing work on ~ property I own or occupy <br /> <br />t(/_?,i, i. i.'O~ai'shg~e to build according to the submitted plans and specifications t he lawe of <br /> <br />~HER PERMITS REQUIRBD BY THIS DEPT.: P~MBING, MECHANICAL~ ELECTRICAL <br /> <br /> <br />