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City ,, ~¢ ~ <br />Zomng Validation <br /> <br />Date ?' ¢¢,¢__ :¢ y ,. <br /> BUILDING [~/MOBILE HOME [] SEPTIC <br /> <br /> Job Address:: <br /> <br /> ._ <br />iwsion Lot <br /> /~o~ ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> Senator Bids, No 22e <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 <br /> Code-A-Phone 4:30 PM, - 8:00 <br /> <br />S e t b_a_c k_.. ~equirements <br /> ~ [Rear <br /> Left Right <br /> <br />PERMIT APPLICATION <br /> <br /> M_~:),in g A,,~dress ~ <br />Site NO <br /> <br />Property 'lax Lot NO <br /> <br />Sp #:: <br /> <br />Oro~ Street / <br /> / <br />Fleet S~C Zone <br /> <br />Total # Spaces <br /> <br />Section <br /> <br />Lot Width:: Lot Depth:: <br /> ¢6 / <br /> <br />Range Zone <br />~M <br />Aer~ breg Lot <br /> <br />Map <br /> <br />Arch~'/Engineer:: <br /> <br />Phone <br /> <br />Phone <br /> <br />Type of Permit New ~'/' Addition f~ Demo <br />¢~6~ Alter [] Relocation [] Ccc Chg <br /> <br /> ............. <br /> Wide, [ Length <br /> <br />Tach <br />Review [] <br />Sq ~t 2nd Floor:: <br />Occupancy:: <br /> <br />Use of Building <br /> <br />Sq Ft Garage Other <br />Occupant Load <br /> <br />Valuation <br /> <br />RES <br /> <br />COM ¢Tl <br /> <br />Proposed Septic installation <br />Previous Sfte Evaluation <br /> Type o_f.. <br /> Test Holes Ready <br /> Will call when holes ready Proposed Bedrooms <br /> <br />Existing Septic System <br /> <br /> Existing Drainfield Length <br /> <br />Type of System:: <br />Bate Tank Pumped Existing Bedrooms <br /> <br />OTHER PERMITS REQUIRED BY THI~ DEPT.:: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Mobile Home Fee <br /> <br />Zoning Surcharge <br />State Surcharge <br />Plans Chock Feo / <br />Site Evaluation Fee <br />Septic Permit Fee <br />DEQ Surcharge <br />Technical Review Fee <br />Reinspection Fee _ ........... <br />Investigation Fee <br /> <br />City Fee <br />TO AL FEE:: 3 o. <br />REGEIPI NO <br /> <br /> <br />