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Zoning Valid~tion..._.._ _.. .... <br />0ate __ <br /> <br /> arty Owner <br />'Job Address <br /> <br /> MARION COUNTY I~IUI/[) I~I~I~N~ F~it~ Requirements <br /> <br /> .... ~ Left <br /> Phone 588-5147 Side <br /> coa~*-.,o.. 4,so ¢,~--~::00 *~RION C0UNT~s <br />BUlLDING~ MOBILE HOME ~ SEPTI¢~DI~[~ATION <br /> ~ ,~ Phone:: Mailing Address <br /> <br /> Subdi'~i~lo~" ---~-- -- '~ ....... <br /> <br /> ~'l~ile Home' Park <br /> Section :~) r ] Township Range <br /> <br /> Lot Depth <br />~ / Acres <br /> <br />Site No t Street <br />Property Tax Lot No Fleet SfC Zone <br />Lot Block <br />Sp # Total # Spaces <br /> <br />Irreg Lot Corner <br /> <br />Contractor Business Name and NO <br />ArchitectCEngineer <br /> <br />Type of New <br />Height of Building <br /> <br />Phone <br /> <br />Phone:: <br /> <br />[] Addition [] Demo:: <br /> <br />No Storie~ <br /> <br />Mobile Home Mobile Home <br />Width Length <br /> <br />[] Occ Chg [] <br /> <br />Sq Ft Main Floor <br /> <br /># Bedrooms <br /> <br />Tach <br /> <br />Review:; [] <br /> <br />Sq Ft 2nd Floor <br /> <br />Use of Building <br /> <br />Sq Ft Garage <br /> <br />Occupant Load <br /> <br />RES <br /> <br />CPM <br /> <br />Other <br /> <br />Proposed Septic Installation <br />Previous Site Evaluation ¢# <br /> <br />Type of System:: <br /> <br />Test Holes Ready <br />Wdl oall when holes ready <br /> <br /> Exishng Septic System <br /> Existing Tank Size <br /> <br />_ Existing Drainfield Length <br /> <br /> / <br /> <br />~///-- ~roso~ed Bedrooms <br /> <br /> Type of System __ <br />__DSte '¢_~nk Pumped <br /> <br />Existing Bedrooms:: <br /> <br />OTHER PERMITS REQUIRED BY THIB DEP'F,: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev I2~87 <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 />Bite Ewluation Fee <br />Septic Permit Fee <br />DEQ Surcharge <br />Technical Review Fee <br />Reinspection Fee <br />Investigation Fee:: <br />City Fee <br /> <br />TOTAL FEE <br />R6CEIPT NO <br /> <br /> <br />