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Received By ~ <br />City .~_.~..~ <br />Zoning .Validation ,~ ..... <br /> <br />pete './-/,,? <br /> <br />BUILDING <br /> <br />MARION COUNTY BUILDING INSPECTION <br />Senator Bids, NO, 229 <br />220 High Stre~ NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 <br /> Code-A-Phone 4::30 RM. - 8::00 A.M, <br /> <br /> MOBILE HOME [] SEPTIC [] <br /> <br />ICily Setback Requirements <br /> <br /> Front ~ · Rear <br /> <br /> Left / Right <br /> Side:: ~ Side <br /> <br />PERMIT APPLICATION <br /> <br />Prope Own <br /> <br />Phone <br /> <br />MailingA~dreea:: ~ / / '/ <br /> Cross Street <br /> <br />Job Address <br /> <br />Site No:: <br /> <br />Property Tax Lot No <br /> <br />Fleet S/C Zone <br /> <br />Subdivision ,~./,~¢.~¢ r~.-* Lot /~" Block:: ,~ <br />Mobile Home Park Sp # Total # Spaces <br /> <br />Section Township Range:: Zone Map;: <br /> Acres:: Irreg Lot <br /> <br />Lot Width <br /> ...... <br /> <br />Lot Depth <br /> <br />OoRtre~tor Business Name and NO "' [ <br />Ars iteot En~neer' - Phone <br /> <br />Address <br /> <br />Address <br /> <br /> Type of Permit 1 ' <br /> New ~.~/ Addition [] Demo [] Tach <br />*' / ~-'~ --'~/S/f/,~ ~J~"ba/ [Alter [~ Relocation [] Ose Ohg L~ Review <br /> / <br /> <br />Height of Building <br /> ._/_¢ <br />Mobile Home <br />Width:: <br /> <br />No Stories <br /> / <br /> <br />Sq Ft Main Floor <br /> <br />Sq Ft 2nd Floor <br /> <br />Mobile Home # Bedrooms Occupancy <br />Length ~ <br /> <br />Use of Building RES <br /> s COM [] <br />Sq Ft Garage Other <br /> <br />Occupant Load War.ply <br /> <br />Proposed Septic Installation <br />Previous Site Ev~tluation # <br /> <br />Type of S.~atem:: <br />Test HOles Ready <br /> <br />Will call when holes r~a.dy <br /> <br />Existing Septic System <br />Existing Tank Size <br /> <br />_Exit_ti09 Dreinfield Length <br /> Type of System <br /> <br />Date Tank,, pu~ped <br /> <br />Proposed Bedrooms <br /> <br />E×Jstin9 Bedrooms <br /> <br />OTHER PERMITS REQUIRED 8Y THI0 IDIEPT,: PI..UMIBING, MECHANICAL, ELECTRICAL <br /> <br />Valuation <br /> <br />Bids Fee <br /> <br />Mobile Home Fee <br />Fleet Surcharge <br />Zoning S~rcharge.~ <br />State Surcharge:: <br />Plans Check Fee <br />Site Evaluation Fee <br />Septic Permit Fee <br />DEQ Surcharge <br />Technical ~"eview Fee <br />Reinspection Fee <br />Investigation Fee <br />City Fee <br /> <br />TOTAL FEE <br />RECEIPT NO <br /> <br /> <br />