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Reeaivee Sy: ~ ~ ¢_.~x¢~, MARION COUNTY BU LB NG NSPECT ON Clty Setback ~aqclremants' / <br /> <br />City ~¢'// ,. ~ ~enator Bldg, No. 22~ ' . ~ . / <br />Zoning VaSdation: ~ '~, ==0 Hl,~e~ ~ Front'. ~ - J Rear'. ~ - j <br /> <br /> BUILDING ~MOBILE HOME ~ SEP~IO'~ ~E~BIT APPMGATION <br /> <br />ProD~'ty Owne~ <br /> <br />Job Address: <br /> <br />Mobile Home Park: <br /> <br />Section: <br /> <br />Lot Width; <br /> <br />Site No,? <br /> <br />Property Tax Lot No,; <br /> / - <br /> <br />Lot; <br /> <br />Sp, ct; <br /> <br />Fleet S/C Zone; <br /> <br />Block]...~ <br /> <br />Total ct Spaces; <br /> <br />Phone: <br /> <br />Address: <br /> <br />Height of Building; <br /> <br />Mobile Home <br />Width: <br /> <br />Addition; E] Demo; 0 <br />Relocation; [] Oct. Chg,; L~ <br /> <br />No. Stories: <br /> / <br /> <br />Mobile Home <br />Length; <br /> <br />Sq. Ft. Main Floor; <br /> <br />Tach, <br /> <br />Review; <br /> <br />Sq, Ft, ~nd Floor; <br /> <br />Use of Building; <br /> <br />Proposed Septic Installation; <br />Previous Site Evaluation #: <br />Type of System: <br />Test Holes Reedy; <br />Will call when holes ready: Proposed Bedrooms; <br />Existing Septic System: <br />Exl¢.n,.g. Tank Size; <br /> <br />Existing Drainfield Lan th' <br />Type Of System; <br /> <br />Date Tank Pumped,,! <br /> <br />Existing Bedrooms: <br /> <br />Valuation; <br /> <br />Bldg. Fee: <br /> <br />Mobile Home Fee: <br />Fleet Surcharge: <br />Zoning Surchsrge: <br />State Surcharge'. <br />Plans Check Fee: <br />Site Evaluation Fee'. <br /> <br />{ ) I have read this application in {ts entirety and certify that the stated information is true and correct to the best of my knowledge. <br />( ~ em performing work on a property I own or <br /> occupy. <br />( ) t am a registered builder OR { )fheauthorizedrepresentatlveofaregistered <br /> <br />( ) The work will be performed by a registered builde~ <br />( ) Other ............ !/// <br />( ) I agree to build according to the sub~Jaed plata.Cd specifications, the laws of <br /> the state of Oregon and the ' ~noes o n County, <br />SIGNATURE OF APPL~~ <br />OTHER PERMITS REQUIRED BY THIS DEPT. f PLUMBING, MECHANICAL, ELECTRICAL <br />MC lS-S <br />Rev. 12187 <br /> <br />Septic Permit Fee; <br />DEQ Surcharge; <br />Technioel Review Fee; <br />Reinsp~')~tion Fee: <br />Investigation Fee: <br />City Fee: <br /> <br />TOTAL FEE: <br />RECEIPT'NO.: <br /> <br />RES <br /> <br />CQM <br /> <br /> <br />