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BUILDING ~ MOBILE HOME ~ SEPTIC ~ PERMIT APPLICATION <br /> <br />Ob Address' <br /> <br />Mobile Home Perk:: <br /> <br />Section Township / Range: <br /> <br />LOt Width:: Lot Depth:: Acres:: <br /> ~; 0 <br /> <br />Phone Mailing Addr, Css:: -(~ ~..~ ' <br /> Site No ~ ~_ Cross Stree~ /,4~ / <br /> Tax Lot No Fleet S/C <br /> <br />Phone:: <br /> <br />Total ,,¢ Spaces <br /> <br />C~,0tra~tor Business_Name end ~No ~ Phone Ad ess '""" ~, <br /> Address:: .... / ........ <br />~rch tect/Enginee~ <br /> <br /> Type of Permit:: "1 New ~ Addition:; r~ Demo:: [] Tach Use <br /> <br />~__ I Alter ~ Relocation <br />,-/:'f [., <br />~'~i""~i}~i/n~:, Sq Fl 2nd Floor:: Sq Ft Garage <br /> <br />Mobile Home <br />Width <br /> <br />Proposed Septic Installation <br />Previous Site Evaluation ¢ <br /> <br />No Stories:: Sq Ft Main Floor <br /> <br />Mobile Home # Bedrooms <br />Length:; <br /> <br />Type of Sygtem <br />Test Holes Ready <br /> <br />Occupant Load:: <br /> <br />Valuation:; <br /> <br />Other <br /> <br /> COM L J <br /> <br />Jpply <br /> <br /> Will call when holes ready Pro~)osed Bedrooms:: <br /> <br /> Existing Tank Size:: <br /> .,~E.,.x,t~ting Drainfield Length:: . <br /> Date Tank Pumped:; ~ Existing Bedrooms:: <br /> I have read this appllcstion in its entir~y and certify th~ the stated information <br /> true and correct to the best of my knowledge <br /> ) I am performing work on a property I own or occupy <br /> <br /> builder <br /> ) The ~rk will be performed by a registered builde~ <br /> <br /> the state of oregon and the ordinances of ~rion County / <br /> <br />OTHER 'ERMITS REQUIRED BY THIS DEP,: P~MBIN~ECHAN,;~, ELE~R,;~ <br />MC 15-6 <br /> <br />Sldg Fee <br /> <br />Mobile Home <br /> <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 />Rein~pection Fee <br />Investigation Fee <br />City Fee:: <br /> <br />TOTAL FEE <br />RECEIPT NO <br /> <br /> <br />