Laserfiche WebLink
City . ~ Senator BlSg. No. <br />Zoning Validation: I~Otr.Lt,.~ r'"': ';z~.t/i~ 220 High Street NE <br /> /i \ '" /,, '.~ Salem, Oregon 9738'1 <br /> <br />INSPECTION <br /> <br />City Setba. ck Requirements <br /> <br />Front: ~ Rear; <br />Loft <br /> <br />1~[~~6BILE HOME [] SEPTIC [] PERMIT APPLICATION <br /> <br />P,~ty OwnFr:a Phone: Maili.~ng Ad%ess: <br />Job Address; / <br /> <br />Cress Street: <br /> <br />Fleet S/C Zone: <br /> <br />S,~/z.ivision; Lot; Block; <br /> m v / l ,,Y/ w_¢ ¢. I <br />Mobile Home Park; Sp. #: <br /> <br />Range; <br /> <br />Map; <br /> <br />Section:all0-5'' !l T0~ip; <br />LOt Width: / L0("iS~ppi~; <br /> <br />Total -~ Spaces: <br /> <br />tCon~ctor Business Name and NO,; <br /> <br /> '~,'~hlteot/Engbeer:..~__~_¢/~/. ~ ~/~,~/?' ...... ,Z//~) <br /> <br /> / Address; <br />Phone;Ph°ne; ~,.~ ~-¢ I A~/d~re15'~ <br /> <br />Ty e of Permit; New: [Z~.'~''' Addition: [] Demo: <br />G/~/j/F.~f,~(~.? Alter; = Relocation: = Ccc. Chg,: <br />Height of B~ilding; No. Stories: Sq. Ft. Main Floor'. <br /> <br />Tach. <br /> <br />Review: [] <br /> <br />Sq. Ft. 2nd Floor: <br /> <br />Use of Building: <br /> <br />Sq, Ft, Garage; <br /> <br /> RES <br /> <br /> COM E3 <br /> <br />Other; <br /> <br />Mobile Home Mobile Home # Bedrooms: OccupanCy; Occupant Load: Supply: <br />Width: Length: ~ <br /> Valuation; <br /> <br />Proposed Septic Installation: <br />Previous Site Evaluagoa #; <br /> <br />Type of ..S),stem; <br />Test Holes Ready: <br /> <br />Will call when holes ready: Proposed Bedrooms: <br /> <br />Existing Septic System: <br /> Existing Tank Size~. <br /> Existing Draiofield Length: <br /> <br />T¥~ of System: <br />Date Tank Pumped: Existing Bedrooms: <br /> <br /> ~--~'¢~'have read this applicatior~ in its entirety and certify that the stated information is <br /> true and correct to the best of my knowledge. <br /> ~¢'_1 al~ perfo[.~ing work on a p Opel y OW~ 00COu~ <br />(~ I am a regictered builder OR ( ) the authorized representative of a registered <br /> <br /> ) The work will be pedofmed by a registered builder. <br /> ) ~ther <br /> <br /> the state of Oregon and the ordinances of ion Co nty. <br /> <br /> HER PERMITS REQUIRED B~ THIS DEP~: PLUMRING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br /> <br />Bldg, Fee; <br /> <br />Mobile Home Fee; <br />Fleet Surcharge: <br />Zoning Surcharge: <br />State Surcharge; <br />Plans Check Fee'. <br />Site Evaluation Fee; <br />Septic Permit Fee: <br />DEQ Surcharge: <br />Technical Review Fee; <br />Reinspectian Fee; <br />Investigation Fee: <br />City Fee; <br /> <br />TOTAL FEE: <br />RECEIPT NO.: <br /> <br /> <br />