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~ecelved <br /> <br />City ' <br />Zoning Validation; .~ ~ - <br /> <br /> BUILDING ~"~MoBiI~E HOME <br /> <br />MARION' C'OUNTY BUILDING INSPECTION <br /> Senator Bldg. No. 225 <br /> 220 High Btreet NE <br /> Salem, Oregon 9730'1 <br /> <br /> Phone 588-5147 <br /> Code-A-Phone 4:30 EM, - 8:0a A.M. <br /> <br /> SEPTIC [] PERMIT APPLICATION <br /> <br />ProperS/Owner;-..., <br /> <br />City Setback Requirements; <br /> <br /> : ~ Rear: <br /> <br />Phone: Ma" g Ad ess: <br /> <br />Job Address: <br /> <br />S u.b~Mslon; <br />.... /.2_elms*' <br />Mobile Home Park: <br /> <br />Section; [ Township; Range'. <br /> <br />Let Width; Lot Depth; Acres: <br /> 25-/ <br /> <br />Site NO.: <br /> <br />Property Tax Lot No.: <br />Lot; <br /> <br />Cross Street: <br /> <br />Fleet S/C Zone: <br /> <br />Block; <br /> <br />Sp. ¢: Total ¢~ Spaces: <br /> <br />[ Zon,~..~ Map: <br />Irreg, Lot; Corner: <br /> <br />tContractor Business Hame and No,; <br />',~hitect/E~-'"'~ <br /> <br />IPhone: <br /> <br /> Phone: <br /> <br />Type of Permit; New: ~ Addition: <br />..J#/V~7'YII~/~'"J'.~--¢'-I~ Alter: [] Relocation'. [] <br /> <br />Height of Building: <br /> /¢" <br /> <br />Mobile Home <br />Width: <br /> <br /> [] Demo; [~ Tach. <br /> Ccc, Chg,: [] Review; <br /> <br />No. Stories: Sq. Ft. Main Flo~r; Sq, Ft, 2nd Floor: <br /> / ., /~ <br /> # Bedrooms'. Occupancy: <br /> <br />Mobile Home <br />Length: <br /> <br />Use ct Building: RES [~ "~"-' <br /> i o <br /> <br />O~upant Load'. j W~V~p,y~ .... <br /> I ~_ <br /> <br />Proposed Septic Installation; <br />Previous Site Evaluation #: <br />Type of System: <br />Test Holes Ready; <br />Will call when holes ready; Proposed Bedrooms: <br />Existing Septic System: <br />Existing Tank Size: <br />Existing Drainfield Length: <br />Type ~.f. System: <br />Date Tank Pumped; Existing Bedrooms; <br /> <br />I have read this application in its entirety and certify that the stated infornlation is <br />true and correct to the best of my knowledge. <br />I 8111 performing work on ~ property I own or occupy. <br />f am a registered builder OR ( ) the autllorized representative of a registered <br />builder, <br />The work will be performed by a registered builjC~r. <br />Other .... <br />I agtee to build according to the~s~bmieed p~/~d specifications, the laws of <br />the state of Oregon and th rd~nanees on County, <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT,; PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15,6 <br /> <br /> Sldg, Fee: $ ~-~//, OO <br /> Mobile Home Fee: <br /> Fleet Surcharge: ~,~" 8 ~/ <br />7oning Surcharge: <br />State Surcharge: ,'/~' '~"~-' <br />Plans Check Fee: /~2 ~ <br />Site Evatuatlon Fee; <br />Septic Permit Fee: <br />DEQ $~charge: <br />Technical Review Fee: <br />Rein8pection Fee: <br /> <br />Investigation Fee: <br />city F~: /~' ES~ <br /> <br /> <br />