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Rece,ved ~y ~--¢/_f ~'~,~ MARION COUNTY BUILDING INSPECTION <br /> <br />Job Address Site No <br /> <br /> Oil_y_ S _e_t ba~c_k R~quirem_e_n!~. ¢ <br /> Front ~ ~, Rear~' <br /> <br /> Left ~ ,, Right <br /> 1Side S I Side <br /> <br />PERMIT APPLICATION <br /> <br />Mailing Address <br /> <br />Lot <br /> <br /> Crr. m4..Street <br /> <br />Fleet S]8'-Zone <br /> <br />Block <br /> <br />Mobile Home P~rk <br /> <br />Section <br /> <br />Lot Width <br /> <br /> Sp # <br /> <br />Lot/Depth~E¢' / Acres trre~ <br /> <br />Map <br /> <br />Total # Spaces <br /> <br />Phone: <br /> <br />-Type of Permit New ~ Addition [] Demo ~ Te~h ....... <br />Q~'/2£7~, Alter L~ Relocabon [] CPo Chg F~ Review F~ <br /> <br />No Stories <br /> ! <br />Mobile Home <br />Length <br /> <br />Sq Ft Main Floor Sq Ft 2nd Floor <br /> <br />Use of Building <br />Sq Ft Garage Other <br /> <br />RES <br /> <br />CPM <br /> <br />Mobile Home <br />Width <br /> <br />_¢~ Ba~oorns <br /> <br />Proposed Septtc Installation <br />Previous Bite Evaluation # <br /> <br />Ty~e of System <br /> <br /> Test Holes Re_a_~y <br /> Will call when holes ready <br /> Existing Soptic System:: <br /> Existin¢~ Tank Size <br /> Existing Drainfield Length <br />____T.y_p_? ct System <br /> Date Tank Pumped <br /> <br />Proposed Bedrooms <br />Existing Bedrooms <br /> <br />~ ,,,~ I am parlor?lng work on 8 property I own or occupy <br /> <br />Occupancy Occupant Load, <br /> <br /> Bldg Fee <br /> <br /> Mobile Home Foe <br /> <br /> Zoning Surcharge <br /> <br /> State Surcharge <br /> <br /> Plans Check Fee <br /> <br /> Bite Evaluation Fee <br /> <br /> Septic Permit Fee <br /> <br />· DEQ Surcharge <br /> <br />OTHER PERMITS REQUIRED Ely THIS DEPT.:: PLUMBING, MECHANICAL, ELECTRICAL <br />MC ~5-6 <br /> <br />Investigation Fee <br /> <br />City Fee <br /> <br />TOTAL FEE <br /> <br />RECEIPT NO <br /> <br />Water Supply <br /> <br /> <br />