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Zoning Validation <br /> <br />City Setback Requireme?s <br />Front ~ t ~_ ~.~t <br /> .... ; I ¢t <br />Side ,~ S~de <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> Senator Bldg. NO,, 225 <br /> 220 High Street NE <br /> <br /> BUILDING [~ MOBILE HOME [] SEPTIC [] PERMIT APPLICATION <br />.~y Owner <br /> /~ J'~ '~f.~.'~'~. r , Ph~,~ne;~ ~,~,~'~7,~ , ..k~ilJng A~dress:: <br /> Site No <br /> <br /> Job Address:: <br /> <br /> /¢u su <br />~lJ.b~vision: . ~, <br /> <br />Mobile Home Park:; <br /> <br />Acres <br /> <br />Property Tax Lot No <br />Lot ,~ <br /> <br />Sp Cf:: <br /> <br />Zone Map <br />"'~5 Corne/~jf <br />Irreg ,~ <br /> <br />Fleet S/C Zone:: <br /> <br />Block:: <br /> <br />Total # Spaces <br /> <br />Co~raotor Business Name and No:: <br />,~rc est/Engineer:: <br /> <br />Phone <br />Phone <br /> <br />Address:: <br /> <br />Address <br /> <br />Type of Permit:: New ~ Addition [] Demo:: [] Tach <br />~/~./)~/'.¢¢~'~/~.~ Alter:: F~ Relocation LJ Occ Chg:: [] Review [] <br /> <br /> Height of Building No Stories Sq Ft Main Floor F-Sq Ft 2nd Floor <br /> <br />-~l~bile Home <br /> Width <br /> <br />Mobile Home <br />Length:: <br /> <br />Bedrooms j Occupancy:: <br /> b <br /> <br />Proposed Septic Installation <br />Previous Site Evaluation # <br />Typ_? <br />Test He[es Ready <br />Will call when holes ready:: Proposed Bedrooms:: <br />Existing Septic System <br />6xieting Tank Size <br /> <br />Existing Drainfield Length <br />Type of System:; <br /> <br /> ~a,,!~,, TaG< ,Pu~mjpe.,d,,: .......................... .E_x!ELn~ Bedrooms:: <br /> <br />{/~ I heYe read this ~ppfication in its entirety and certify that the ststed information is <br /> ue and correct to the best of my Rnowledge <br />( ~sm performing work on a property I ~n or occupy <br />f~) I am a registered builder OR ( ) the authorized representative of a registered <br /> builder <br />( j Th Work Will bo performed by a registered bul~der <br /> <br />~HER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICA~ <br /> <br />Use of Building RES ~,- <br /> Valuation $~ O0 <br /> <br />Bldg Fee:: $ <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 />c,t, <br />TOTAL FEE _ .......... <br /> <br /> <br />