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BUILDING <br /> <br />IProperty Owner ~ <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;$0 EM, - 8::00 AM <br /> <br /> MOBILE HOME [] OEPTIC [] PERMIT APPLICATION <br /> Phone Maili/:~ Address <br /> <br /> Site No <br /> <br />S/~/~visie n <br />Mobile Home Park <br /> <br />Section <br /> <br />Let Width <br /> <br /> Toe,p:: R e ngc~e ~.// <br />· I <br /> <br />[Con~ractor Business' Name and No <br />Architect/Engineer <br /> <br />Property Tax Lot No <br />Lot ~ <br /> <br />Sp ¢ <br /> <br />Phone <br /> <br />Phone:: <br /> <br />Map <br /> <br />Cross Street <br /> <br />Fleet S~C Zone <br /> <br />Block <br /> <br />Total # Spaces:: <br /> <br />Irregp4~) Corn~/.~ <br /> <br />Address:: <br /> <br />Address <br /> <br />Type of Permit <br /> <br /> of Building <br /> <br />Mobile Home <br />Width <br /> <br />New [] Addition ~ Demo [] <br />Alter E~;k''''/' Relocation ~J Ccc Chg [] <br /> <br />No Stories <br /> / <br /> <br />Sq Ft Main Floor <br /> <br />Mobile Home # Bedrooms <br />Length <br /> <br />Proposed Septic Installation <br />Previous Site Evaluation #:: <br /> <br />]-y~.,of System <br />Test Holee Reedy <br /> <br />Will call when holes reedy:: <br /> <br />Proposed Bedrooms <br /> <br />Existing Septic System:: <br /> Existing T~nk Size <br /> Extsti_n9. Orainfield Length <br /> Type of System <br /> <br /> Date Tank Pumped _ Existing_B_ed(,ooms <br /> <br />~¥"' I have read this ~pplication in its entirety and comfy that the stated ~nfornlabon is <br /> true and correct to the best of my knowledge <br />V~"l am performing work on a property I own or occup~ <br /> I am a ceg~steced builder OR f ) the authorized representative of a registered <br /> builder <br /> The work will be performed by a registered builder <br /> Other <br /> <br /> Tach <br /> <br /> Review <br /> <br />Sq Ft ~nd Floor <br />Occupancy <br /> <br />Uae of Building ,, ....... l- ' F~-S ~ <br />8q Et Garage Other &¢'¢~?~'/-¢7'/ <br />Occupant Load Wat~ Supple ~ <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT,: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev 12/87 <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 />Reinspection Fee <br />Invesbgation Fee <br />City Fee:: __ <br />TOTAL FEE <br />RECEIPT NO . _ .... <br /> <br /> <br />