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zC~ng Va]l~bon ~' ~, <br /> <br /> BUILDING ~/"MOBILE HOME [] <br /> <br />,..~/,~r ty Owj3~ r <br />Job Address <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />Subdiv~'~,n <br /> <br />Mobile Home Park <br /> <br /> ~enetor Bldg.. No.. 225 <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone ess-s147 <br />Code. A-Phone 4;30 RM. - 8:00 A.M. <br /> <br />SEPTIC [] <br /> <br />City Setback R~._e.~uirem.?nts . .... <br /> <br />Front ~ / Rear ,:~-/ <br />Side:: ~ ¢ Side:: ~ <br /> <br />PERMIT APPLICATION <br /> <br />Phone <br /> <br /> M~ling Ad.dress;: ~ <br />Site No Qr_oss Street <br /> <br />Pre, arty Tax Lot NO Fleet S/C Zone <br />Lot¢ <br />Sp ¢:: To~al ¢ Spaoes <br /> <br />Section <br /> <br />Lot Width::/ <br /> <br />Township:: <br /> <br />Lot Depth:: <br /> '7/ <br /> <br />Ra m <br /> <br />Zon~ ~,,~ Map <br />Irreg,)"~-~'~,~'~r°'t ~4¢- <br /> <br />'~ctor Business Name and No '[ Phone <br />Architect~Engineer ~, <br /> <br />Address <br /> <br />Address <br /> <br />Type of Permit:; <br /> <br />Height of Building <br /> <br />Mobile Home <br />Width <br /> <br />New ~ Addition:: ~ Demo [] Tech <br />Alter:: [] Relocation:: [] Ccc Chg [~ Review:: [] <br /> <br />NO Stone's:: <br /> / <br /> <br />Sq Ft Main Floor Sq Ft 2nd Floor <br />/oo8 <br /># Bedrooms:: Occupancy <br /> <br />Propoaed Septic Installation <br />Previous Site Evaluation # <br /> <br />.... Ty.pe of System <br /> <br /> Test Holes Rea,d..y: <br />Will call when holes ready .... <br />Existing Septic System <br />Existing Tank Size:: <br /> <br />Existing D rainfield_. _Length:: <br />Ty~o _e. ~f .~.y_Stem <br />Date Tank Pumped <br /> <br />Proposed Bedrooms <br /> <br />Existing Bedrooms <br /> <br />Mobile Home <br />Length:: <br /> <br />The work will be performed by a registered builder <br />Other ....... <br /> <br />Use of Building RES [:~ / <br /> <br />Sq Ft Garage Other <br />Occupant Load Ware ~upply <br /> <br /> Valuation <br /> <br /> Bldg Fee:: <br /> <br />Mobile Home Fee <br />Fleet Sumharge <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 />~TOTA L FEE <br />RECEIPT NO <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.:: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br /> <br />15¢, .25 <br /> <br /> <br />