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Reoeive~ By <br /> <br />City <br />Zoning V~idation <br /> <br />Date:: ~._.~_ /2--- u <br /> BUILDING ~r/MOBILE HOME [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br />Senator Bldg.. NO. 225 <br />220 High Street NE <br /> ~ ~" Salem, Oregon 97301 <br /> <br /> Phone 588-5147 <br /> Code-A-Phone 4:30 PM. - 8;00 A.M. <br /> <br /> SEPTIC [] <br /> <br /> City Setback Require~n__ts <br /> <br /> Front::~ Rear ~ / <br /> L~- ---- Right ---- <br /> / Side ~ ! J Side ~ / <br />PERMIT APPLICATION <br /> <br />Job Address <br /> <br /> Site No C'~ Street <br /> <br /> Property Tax Lot No Fleet S/C Zone:: <br />,, ¢ <br />Lot Bloc~ <br /> // <br /> Sp ¢ Total ¢ Spaces <br /> <br />Section Township Range:: Map <br /> Acres <br /> <br />Lot Width <br /> <br />Lot Depth:: <br /> <br />Phone <br /> <br />Phone:: <br /> <br />Address <br />Address <br /> <br />Type of Permit / New I~ Addition F~ Demo <br />/~ / ~.. ~ Alter:: [] Relocation [] Ccc Chg <br />, . ....... <br />Height,)°f ('f/ !Building:: No, Stories/ . Sq Ft/~Main Floor:: <br />Mobile Nome Mobile Home # Bedrooms:: <br />Width Length ~ <br /> <br />[] Tach <br /> <br />[] Review [] <br /> <br />Sq Ft 2nd Floor <br /> <br />Occupancy <br /> <br />Proposed Septic Installation <br />Previous Site Evaluation # <br /> <br />._ _Type. ~!,_S_ystem:: <br /> <br />Test Holes Reedy <br /> <br />Will call when holes ready:: <br /> <br />Exieting Septic System:: <br />Existing Tank Size <br /> <br />Existing Dralnfleld Length <br /> <br />Tygff o_f~etem <br /> <br />Proposed Bedrooms <br /> <br />Date Tank Pumped <br /> <br />Exietin9 Bedrooms <br /> <br />OTHER PERMITS REQUIRED BY THiS DEP'F: PLUMBING~ MECHANICAL, ELECTRICAL <br /> <br />Use of Building:: <br />Sq ~t Garage <br /> <br />Occupant Load <br /> <br />Valuation <br />81dg Fee $_ c~4~¢, ~"~) <br /> <br />Mobile Home Fee <br />Fleet Surcharge __ ~' ~----- <br />Zoning Surcharge:: <br />State Surcharge <br /> <br />DEQ Surcharge <br /> <br />Technical Review Fee <br /> <br />Rein~pection ~e <br /> <br />TOTAL FEE <br /> <br />RECEIPT NO :: <br /> <br /> <br />