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zC~nYing Validation <br /> <br />BUILDING [~/ MOBILE HOME [] <br /> <br /> ro3 ty owr <br /> <br />Job Address:: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> SEPTIC [] <br /> <br />Mobile Home Park:: <br /> <br />Section:: <br /> <br />Lot Width <br /> <br />Tow ~h~p Range:: <br />Lot Depth Acres <br /> <br /> .~F,C, rl~y Setback Requirements <br /> nt ~ / Rear <br /> <br /> [ ~'e~-- -- ! Right <br /> tSide ,f Side <br /> <br />PERMIT APPLICATION <br /> <br />Site No <br /> <br />Property Tax Lot NO <br /> <br />Lot <br /> <br />Sp- #:: <br /> <br />Mailing Address <br /> <br /> Cross Street <br /> <br />Zone:;,;~ .~' Map:: <br /> <br />Irreg Lot:: Corner <br />Yes /Va <br /> <br />Total # Spaces <br /> <br />![-~{~actor Business Name and No <br /> <br /> - <br /> <br />Type of Permit <br /> <br />New <br /> <br />Alter <br /> <br />Addition:: [] Demo <br /> <br />Sq Ft Main Floor <br /> <br /># Bedrooms <br /> <br />[] Tach <br /> <br />[] Review:: <br /> <br />Sq Ft 2nd Floor <br /> <br />Height of Building No Stories:; <br /> <br />Mobile Home Mobile Home <br />Width Length :: <br /> <br />Proposed Saptic Installation <br />Previous Site Evaluation # <br /> <br />Type o¢.S_y, stem <br />Test Holes Beady;: <br /> <br />PrOposed Bedrooms:; <br /> <br />Will call when holes ready:: <br /> <br />Existing Septic System <br />_ Existing Tank Size;: <br /> <br />Existing Bedrooms;: <br /> <br />Existing_ D_ratnfield Length <br />Type of System <br /> <br />Use of Building:: <br /> <br />Sq Ft Garage:: <br /> <br />Occupant Load <br /> <br />Date Tank Pumped:: <br /> <br />Occupancy <br /> <br /> builder <br /> <br />f ) ~ agree to build according to the submitted~_.cl:ltans and ;.sj~e¢lc~ion$, the law~ of <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br />MC ~5-6 <br /> <br />Valuation <br /> <br />Bldg Fee:: <br /> <br />Mobile Home Fee <br />Fleet Surcharge <br />Zoning Surcharge <br />State Surcharge:: <br />Plans Check Fee <br />Site Evaluation Fee <br />Septic Permit Fee <br />DEQ Surcharge:: <br />Technical Review Fee <br />ffeinspection Foe <br />Investigation Fee <br />~Ci~y Fee <br /> <br />TOTAL FEE <br />RECEIPT NO:: <br /> <br />Other <br /> <br />RES <br /> <br />COM <br /> <br />S. upply <br /> <br />$ ). oO <br />$, <br /> <br /> <br />