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Received Sy ~ ~, L,~'Z~'..__ - MARION COUNTY BUILDING INSPECTION City Setback Requirements:: <br />oty //']. ~n~,or ",dg..o- 2~. ~nt ¢¢.Z¢ R~¢__Z <br />Zoning Validation ~-~ 220 High 9t~t NE <br /> <br /> BUILDING ~ MOBILE HOME ~ SEPTIC ~ PERMIT APPLICATION <br /> Property O~r ~hng Address <br /> <br />Job Address <br /> <br /> 97o <br /> <br />Mobile Home Park <br /> <br />Section <br /> <br />Lot Width <br /> <br />Township <br /> <br />Lot Depth:: <br /> <br />Acres <br /> <br />Property Tax Lot No <br />Lot <br /> <br />Zone:: Map <br />'~' ~ Corn <br />Irreg Lot <br /> <br />crc'"; ¢h¢-~-: 7/,,/. 4, .¢__.' <br /> <br />Fleet S/C Zone <br /> <br />-':Fois, l /I Spaces <br /> <br />Phone <br /> <br />Addr~s <br /> <br />Phone Address <br /> <br />Type o-f Perr~it <br /> <br /> , <br /> <br />New ~ Addition ~ Demo: ..... ~- Tach <br /> <br />Alter [] Relocation:: [] Ccc Ch9 [] Review <br /> <br />Sq Ff Main Floor:: Sq Ft 2nd Floor <br /> //~0 <br /> <br />Bedrooms <br /> <br />Use of Building RES <br /> <br />Sq Ft Garage Other <br /> <br />Occupant Load Water~ply <br />Valuation $ ~-~5~ <br /> <br />Height of Building No Stories <br /> <br />Mobile Home Mobile Home <br />Width Length <br /> <br />Proposed Septic Installation <br />Previous Site Evaluation # <br /> <br />Proposed Bedrooms <br /> <br />Test HOles Re~d? <br />Will call when holes ready <br /> <br />Existing Septic System <br /> Existing 'i"enk Size <br /> Existing Drainfiold Long.th <br /> type of System <br /> <br />$×isting Sedr0oms <br /> <br />Da_t~ Tank Pumped <br /> <br />Bldg Fee $ .. <br />Mobile Home Fee <br />Fleet Surcharge <br />Zoning Surcharge <br />State Surcharge <br />Plans Cheek Fee <br />Site Evaluation Fee ............ <br />Septic Permit Fee <br />DEQ Surcharge <br />Technical Review Fee <br />Rein'~=pection Fee:: <br />Investigation Fee <br />City Fee:: <br /> <br />RECEIPT ,O <br /> <br /> I I h~zve read this application ~n its entirety and certify that the stated information ~s <br /> troe 8nd corroct ~o (i~o bo.~t ol r~y knowlodge <br /> ~ I ~lm performing work on a property I own er occupy <br /> <br />OTHER PERMITS B~=OUIRBD BY THIS DEPT. ii PLUMBING, MI=OHANICAL, ELECTRICAL <br /> <br />Occupancy <br /> <br /> <br />