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Received Sy; <br /> <br />City ~' <br />Zoning Validation; <br /> <br /> / <br /> <br />BUILDING L...~ MOBILE HOME [] <br /> Phone~._ <br /> <br />MARION COUN~;Y BI.~II~ IC~IS~ECT~ION~ ~t~.,S~etback Requirements: <br /> <br /> Salem Oregon 97301 L ~ft ~/ ~ R~ght ~-~-'-'--[ <br /> APPLICATIO~ <br /> <br />Mobile Home Pa~k: <br /> <br />Site NO.: <br /> <br />Tax Lot No,: <br /> <br />Section; Range; Map: <br /> <br />Fleet S/C~,~e; <br />Block: <br /> <br />Acres: <br /> <br />Contractor Bu,~Name and <br /> <br />No,; Phone: <br /> Phone; <br /> <br />Type of Permit: New: I[;~.-''~'''- Addition: [] <br /> <br /> ild~g: No, Sto <br /> <br />Mobile Home Mobile Home <br />Width: ¢ Length; -- <br /> <br />Demo: [] Tach, <br />Ccc. Chg.: [] Review; <br /> <br />Main Floor; Sq <br /> <br />Proposed Septic Installation: <br />Previous Site EValuation #: <br /> <br />Type of SyStem; <br />Test Holes Ready: <br /> <br />Will call when holes reedy; Proposed Sedrooms: <br /> <br />Existing Septic System: <br /> Tank Size'. <br /> Drainfiald Length: <br /> System: <br /> <br />Bedrooms; <br /> <br />(~)~) I have read this applioation in its emirety and certify that the ~tated information is <br /> true and COrrect to the best ct my ~<nowledge. <br />( '~ ) I am performing work on a property I owr~ or occupy. <br /> I am a registered builder OR ( ) the authorized representative of a registered <br /> <br /> Other <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Address; <br /> <br />RES <br /> <br />CCH <br /> <br />Valuation; <br /> <br />Bldg. Fee: <br /> <br />Mobile Home Pea: <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 />City Fee: <br /> <br />TOTAL FEE: <br />RECEIPT NO.: <br /> <br /> <br />