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Reoe,ved Ey: y ~M~':~-Ribl~l c~ouNT -BUIL~ING ~lem~ Oregon 97~01 BU LD ~ ~B LE HOME ~ SEPTC ~ PERMIT APPLICATION City Setback Requifements~ Front: ~,.~O /~Rear: Left ,.~,_ / L Right Side: ~ Side: Prop_cr, t y Owne,~ /~ p,llng ,~ddress; ~ / - ' -- Job Address: Mobile Home Park; Lot Width: Lot De th: Site NO.: Property Tax Lot NO.: Fl~e.t S~'~ Lot; Sp, ,¢; ZO,~,,~ Map: Irreg, Lot; C,,~; Total ¢~ Spaces; Arch' ct/Enginee ' , Phone~ I Address; Phone: Addre~; ,~e of Permit: Height of Building; Mobile Home Width: New: ~ Addition: [] Demo: ~ Tach. Alter: [] Relocation'. [] Ucc, Chg,; [] Review: [] No, Stories: / Mobile Home Length; ~ Sq, Fl, Main Floor: Sq. Ft, 2nd Floor: Occupancy: Use of Building; RES B~ Sq. Pt. Garage: Other: Occupant Load; pply: Proposed Septic Installation: Previous Site Evaluation ~¢; Type of_,,S,¥stem; Test HOleS Re,dy; Will call when holes ready: Proposed Bedrooms: Existing Septic System: Existing Tank Size; ,Existing Drainfield Length: Type of Date Tank Pumped: Existing Bedrooms: )I have read this applicatio~ in its entirety and certify that the stated information is true and correct to the beet of my knowledge. )~ am performing work on a property I own o¢ occupy, ~ f am a registered builder OR ( ) the authorized representative of a registered builder. ) The work will be performed by a registered builder. ) I agree to build according to the sugmttlo and specifications, the lawe of SISNATURE OF A ~ OTHER PERMIT~ REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL Valuation: Bldg, Fee: Mobile Home Fee; Fleet Surcharge: Zoning Surcharge: State Surcharge: Plans Check Fee: Site Evaluation Fee; Septic Permit Fee: I~EQ Surcharge; Technical Review Fee; Reinspectlon Fee; Investigation Fee: City Fee: TOTAL FEE: RECEIPT NO.;