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R,ecelved By: ~L~¢~'~. MARION COUNTY BUILDIN~E~TION I Clty Setback Requirements; <br />City ' ~/ ~,,¢¢/~ senatorBIdg, No. 2~r~ ~//~ ~ ~ _/_ , ~ IR r' <br />Zoning Valid~on: ,.~~ 22o High mm~ ~ <br /> <br />Date: ~¢ ~ PhoneS~47 <br /> <br /> Property 0 PhOne; "' ' <br /> <br /> Job ~dress; Site NO.: Dross <br /> 9/~ ~ ~''1//~ Property Tax Lot No.: Fleet S/C Zone'. <br /> <br />Subdivisief~ <br /> <br />Mobile Home Park: <br /> <br />Section: i Township; <br />Lot Width: Lot Depth: <br /> <br />Block: <br /> <br />Total ¢ Spaces; <br /> <br />Range; <br /> <br />Irreg, Lfl~ <br /> <br />Map; <br /> <br />Corner: <br /> 3/o <br /> <br />JCoD~actor Business Name and No.: <br /> <br /> "'~itee~6ngineer; ,, <br /> <br />Phone: <br /> <br />Phone: <br /> <br />Ad tess: <br /> <br />Address: <br /> <br />~ Addition: [] Demo; [] Tech, <br />[] Relocation; ~ Occ, Chg,: ~ Review; <br /> <br />Height of Building; <br /> <br />Mobile Home <br />Width: <br /> <br />No. S;ries: <br />Mobile H~'~ ....... <br />Length; <br /> <br />Sq. Ft. Mein Floor: <br /> <br />Sq. Ft, 2nd Floor: <br /> <br /># Bedrooms; Occupancy: <br /> <br />Proposed Septic Insta,ation; <br />Previous Site Evaluation #: <br /> Type of System'. <br /> <br />Test Holes Ready.: <br />Will call when holes ready: <br /> <br />Proposed Bedrooms; <br /> <br />Existing Septic System: <br /> Existing Tank Sise; <br /> Existing Dralnfield Length: <br /> Type et,,~stem: <br /> <br />Date Tank Pumped: <br /> <br />Existing Bedrooms: <br /> <br /> ) The work will be performed by a registered builder, /7 <br /> <br /> ) I agree to build according to the sub.,J~A¢'~¢~ plan¢¢p/e/Cifications, the laws of <br /> <br />OTHER PERMITS REQUIRED BY THIS DEP'[: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Use of Building; RES <br /> COM ~ <br />Sq, Pt, Garage; <br /> <br />Occupant Load: <br /> <br />Valuation: $ ..... <br />Bldg. Fee: $__~. <br />M~ile Home ~ee; <br />Fleet S~harge; '~, <br />Zoning Surcharge; ............ <br />State Surcharge'. /~(_¢_~ .... <br /> <br />Site Evaluatio~ Bee; <br /> <br />Septic Permit Fee: <br /> <br />DEQ Suroh~rge: <br /> <br />Technical Review Fee: <br /> <br />Reinspecgon Fee; <br /> <br />Investigation Fee: <br /> <br />City Fee; <br /> <br />RECEIPT ~0,; <br /> <br /> <br />