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Property Owner; Phone; <br />Job Address: <br /> <br />Mobile Home Park: <br /> <br />Section; <br /> <br />Town~hlp~ <br />Lot [~e th; <br /> I~0 / <br /> <br />MARION COUNTY BUIL~Nt~IGJNSPECTION City Setback Reguirements: <br />Senator Bldg.j~l~]~2~l-~ J~ ~ . ~-- I )'3 ~er~ <br /> <br /> .henesss-5~47 ;~" o ..... ~ IJSi~; ~ [Side; <br /> Cod~A-Phone 4'30 RM - e'00'A,~ ¢3 '; 7~:,~ t---" <br /> <br /> SEPTI&~0~TAPPLICATION <br /> <br /> Site NO.: ' Cross,treat: / <br /> <br />Range: Zone: <br />Acres: Irreg. Lot: <br /> <br />Lot; <br /> <br />Sp,#: <br /> <br /> Z <br /> Map~; <br /> <br /> Corner; <br /> <br />Block: /'-7 <br /> <br />Contractor Business Name and No,: Phone: Address; <br />Architect/Engineer,, Phone; Address: <br /> <br />Type, o~ermit: --~ ~ 0 Tach, <br /> <br /> New; [] Addition; Demo: <br /> Alter: [] Relocation: [] Ccc. Chg.; <br /> <br />Height¢!of Suildin~ I NO, Stories: Scl, Ft, Main Floor: <br /> <br />Mobile Home ~^ / --'"' 'l~l~'b ~ ~ ~'~.~j~ ¢~ ~ ~,drooms: <br /> <br />Sq. Ft. 2nd Floor; Sq. Ft. Garage: Other: <br />Occupancy; Occupant Load; <br /> <br />Proposed Septic Installation; <br /> Previous Site Evaluation ¢; <br /> Type of System: <br /> <br />Test Holes Ready; <br />Will Ce, ti when holes ready: Proposed Bedrooms: <br />Existing Septic System; <br />Existing Tank Size: <br /> <br />Existing Drainfield Length: <br />Type of S stem' <br /> <br />Date Tank Pumped: <br /> <br />Existing Bedrooms; <br /> <br />( ~ I hove reed this application tn Its entirety and certify that the stated information is <br /> true and correct to the best of my knowledge. <br /> )4 1 am performing work on ~ property I own or occupy. C=C,r¢. <br /> I am a registered builder OR ( ) the authorized representative of a registered <br /> builder. <br /> The work will be performed by a registered builder. <br /> Other <br /> ~.. I agree to build according to the submitted plans arid specifications, tl~e laws of <br /> <br />OTHER PERMITS REQUIR , ELECTRICAL <br /> <br />RES <br /> <br />COM rq <br /> <br />Valuation; <br /> <br />Bldg. Fee'. $ <br /> <br />Mobile Home Fee; <br />Fleet Surcharge: <~. <br /> <br />Zoning Surcharge: <br /> <br />State Surcharge; <br />Plans Check Fee'. q, z~_~_ <br />Site Evaluation Fee: <br />Septic Permit Fee: <br />DEQ Surcharge: <br />Technical Review Fee: <br />Relnspaction Fee; ............................... <br /> <br />investigation Fee: <br />CityFee: --- t ~"~ <br />TOTAL FEE', ~' <br />RECEIPT NO,; ............ <br /> <br /> <br />