Laserfiche WebLink
Zen ng Va dation~ t_! ~Y _~z'- <br /> <br />MARION COUNTY B I~{NSPEC'E, IOr~~ tY Setback Requirements; <br /> <br /> ~alem, Oregon 97301 ' r , . <br /> ~ - : , , ' 'l'~eft ' ... Right <br /> <br /> BUILDING [] <br /> Property Owner: ,/~ ~ I / ~ '~" ' F Phone; <br /> <br /> Mobile Home Park; ' ' <br /> <br /> ga: _ _ zone:~ / 'Map: <br /> <br />Lot Width: '", I Lot Depth: '" Acres: / rre.~!~t:// C~ner'. <br />..... i I <br /> <br /> Code-A-PSone 4'$0 RM ~8~A';~I~ ~ , <br /> _ <br />MOBILE HOME I I <br /> <br /> Sjte ~o,: <br /> <br />Contractor Business Name and No~~ <br /> <br />Architect/Engineer; <br /> <br />Phone; <br /> <br />Phone: <br /> <br />Address: <br /> <br />Address: <br /> <br />Tyl~e of Permit; <br /> <br />Height of BuJldt~ <br /> <br />Width; '~--- <br /> / <br /> <br /> / <br />Proposed Septic Installatlon; <br />Previous Site Evaluation #: <br /> <br />New: [~/r Addition; D Demo; <br /> <br />Alter: [] Relocation: [] Ccc, Chg,: <br /> <br /> / / <br /> <br /> Type of,,~ystem: <br /> Test Holes Ready: <br />Will call w_h~? holes ready: <br />Existing Septic System'. <br />Existing Tank Size; <br /> <br />Proposed Bedrooms: <br /> <br />Existing Drainfield Length; <br />~Typ¢ of System: <br />Date Tank ~umped: Existing Bedrooms: <br /> <br /> Tach. <br /> <br />[] Review: [] <br /> <br />(/"-) Ihavere~zdthisapplloetloninttsenlitetyandcertifythatlhestatedlnformationis <br /> ~rue and corre~ ~ the best ~ my knowledge. <br /> <br /> ~.The work ~11 be Eerforme~ ~ a registered builder, ~ ' <br /> Other, (~h ~ ~ <br /> ) I agree to build ~oordJng to the submifled plans and sp~lflcations, the law~f <br /> <br />SIGNATURE OF APPLICANT: ~_ j ~. ~ __ . <br />OTHER PERMITS REQUIRED DY THI!B DEPT,: PLUMBIN~MECHANICAL, ELECTRICAL <br /> <br />MC 15-6 <br />Rev, 12/87 <br /> <br />Use of Building: J RES <br /> ~ i~J COM [] <br />[¢~ / O~_~-~,..,,.,j .......... <br />Sq'. F~r¢ [ Other; ~ A <br />./~. L_. /~ .... <br />O~upafit Load: / ~r,~p~ly; <br /> <br /> Valuation: $. <br /> <br />aldg, Fee; <br /> <br />Mobile Home Fee: <br />Fleet Surcharge; <br />Zoning Surcharge'. <br />State Surcharge; <br />Plan8 Check Fee; <br />Site Evaluation Fee; <br />Septic Permit Fee: <br />DEQ Surcharge: <br />Technical Review Fee: <br />Relnspeotion Fee'. <br />Investigation Fee; <br />City Fee: <br /> <br />TOTAL FEE; <br />RECEIPT NO.: <br /> <br />$. <br /> <br /> <br />