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Race, ired By <br />City (~' <br /> <br />BUILDING <br /> <br />MARION COUNTY BUILDING INSPECTION <br />Senator Bldg. NO 225 <br />2¢,g High Street NE <br /> Salem, O~gon 97301 <br /> <br /> Phone ~18-5147 <br /> Code-A-Phone 4:30 EM. - 8;;00 A,M. <br /> <br />City Setback Requirements <br /> Er°n' <br /> Left ~,~ / Right <br /> Side Side <br /> <br />HOME [] SEPTIC [] PERMIT APPLICATION <br /> <br />Mailing Address:; <br /> <br />Job Address <br /> h5-5'- <br /> <br />Subdivision:: <br /> <br />Mobile Home Park:: <br /> <br />Section <br /> <br />Lot Width <br /> <br />Site No,:; <br /> <br />Property Tax Lot NO <br /> <br />Lot:; <br /> <br />Sp, ¢ <br /> <br />Zone:: I,%_~_ <br /> <br />Fleet S¢C Zone <br /> <br />Block:: <br /> <br />Total # Space: <br /> <br />Contrac'[or Business Name,,,, <br />Architect/Engineer <br /> <br />Address <br /> <br />Phone:; Address <br /> <br />';rype of Permit J New <br />Height of Building:; <br /> <br />Fi Addition [] Demo:: [] Tach <br />[] Relocation [] Ccc Chg [] Review <br /> <br />Mobile Home <br />Width:: <br /> <br />tNo Stories:: <br /> <br /> Mobile Home <br /> Length;; <br /> <br />Sq Ft Main Floor <br /> <br />Sq,, Ft,, 2nd Floor:; <br /> <br />Use of Buildir~g" .... I--RES -- ~._- <br /> <br />Sq Ft Garage <br /> <br />Occupant Load <br /> <br />Other:: <br /> <br />Proposed Septic Installation:: <br />Previous Site Evaluation # <br /> <br />~,p,¢ ,of System:: <br /> <br />Test Holes Rea~,, <br />Will call when holes ready:; <br /> <br />Existing Septic System' <br />~xisting Tank Size:: <br /> <br />Proposed Bedrooms:; ' <br /> <br /> Existin~ Drainfield Length:: <br /> Typ~e of System ...... ~4~ ~.~ ~ <br /> Date Tank Pumped:: ~-/[~),~,, ,/~ Existing Bedrooms 3 <br /> <br />OTHER PERMIT$ REQUIRED BY THIS DEPT.: PB~BI~6, aECHANICAL, ELECTRICAL <br /> <br />Valuation <br /> <br />Bldg Fee <br /> <br />Mobile Home Fee <br />Fleet Surcharge:: <br />Zoning Sumharge:: <br />State Surcharge:: <br />Plans Check Fee <br />Site Evaluation Fee <br />Septic Permit Fee <br />DEQ Surcharge <br />Technical Review Fee <br />Relnspection Fee <br />Investigation Fee:: <br />City Fee <br /> <br />TOTAL FEE:: <br />RECEIPT NO:: <br /> <br /> <br />