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MARION COUNTY BUILDING INSPECTION <br /> Senator Bidg.. NO.. 225 <br /> 220 High Street NE <br /> Salem~ Oregon 97301 <br /> <br /> Pl~one 588-5147 <br /> Code-A-Pllo~e 4;;30 RM. - 8;;00 A.M.. <br /> <br />BUILDING [~ MOBILE HOME [] SEPTIC [] <br /> <br />City Setback Requirements <br /> <br />Front ~ / Rear ~;,,~- / <br />...... ............ <br />Side <br /> <br />PERMIT APPLICATION <br /> <br />.... ~-/d/cC Z~'r,¢¢¢~yZ~-~¢J~/2 _ <br />~ob Address <br /> <br />SuP(J~tiBiOn <br /> <br />Mobile Homo Park <br /> <br />Phone <br /> <br />Property Tax Lot No <br /> <br />Lot <br /> <br />Sp # <br /> <br />Cross Street. <br /> <br />Fleet SIC Zone <br /> <br />Block <br /> <br />Total ,¢ Spaces:: <br /> <br />Lot Width <br /> ' <br /> <br />Township Range:: <br />Lot Depth A0res <br /> <br />I~r~-r,~oio~ Business Name and No <br />Architect Engineer <br /> <br />Phone Address <br />Phone <br /> <br />Address <br /> <br />Type of Permit <br /> <br />Height ~lding <br />Width <br /> <br />New ~ Addition <br />Alter [] Relocation <br /> <br />NO Stories <br /> / <br /> <br />[] Demo ~ Tech <br />7 Ccc Chg [] Review <br /> <br />Mobile Home <br /> <br />Sq Ft 2nd Floor <br /> <br />Occupancy <br /> <br />Proposed Septic installation <br />Pre~ious Site Evaluation # <br /> <br />Typo of System <br /> <br />Test Holes Ready <br /> <br />Wdl csJl when holes ready <br />Existing Septic System <br /> <br />Existing Tank Size <br /> <br />Ex~ste~g Orainfield Length <br />Ty. pe o_f .System ...... <br />Date Tank Pumped <br /> <br />JSq Ft Main Floor <br />/1 6 <br /> # Bedrooms <br /> <br />Proposed Bedrooms <br /> <br />Length:: <br /> <br />Existing Bedrooms <br /> <br />Use of Buitding <br /> <br />RES ~ <br />COM E3 <br /> <br />Sq Pt Garage <br /> <br />Occupant Load <br /> <br /> I am a registered budder 0~4 ~ <br />~builder ~ t~o autSorrzed representaS~e of a registered <br /> <br />SIGNATURE OF APPLICA <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.:: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15.6 <br />ROy 12,87 <br /> <br />Valuation <br /> <br />Bldg Fee <br /> <br />Mobile Home Fee <br />Fleet Surcharge <br />Zoning Seroharge <br />State Surcharge <br />Plans Check Foe <br />Site Evaluation Foe <br />Septic Permit Fee <br />OEQ Surcharge <br />Technical Review Fee <br />Reinspection Fee <br />investigation Fee <br />City Fee <br /> <br />TOTAL FEE <br />RECEIPT NO <br /> <br />.... Other <br /> Wot Supply <br /> <br /> ..z. <br /> <br />. ,5 ¢ _ __ <br /> <br /> <br />