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BUILDING ~ MOBILE HOME D SEPTI~/~~LIcATION <br /> <br />Job Address: Bite No.: Cross Street; <br /> <br />Pro arty Ts× Lot No,; <br /> <br />F~eet SIC Zone: <br /> <br />B¢3division :r~,. Lot: ~ Block: <br />Mobile Home Park'. Sp, ~; Total # Spaces: <br /> <br />Section'.~ ToT~hip;. Range;~) ~ ~o~ Map; <br />Lot Width: Lot Depth: Acres: Irreg; ~; Co~n~; <br /> <br />Contfr,.aotor Business .~)n~e and NO,; J Phone: <br />~/~'¢ineer; / Phone; <br /> <br />Address: <br /> <br />Address; <br /> <br />Type of Permit; New: ~ Addition; [] Demo: [] Tach, <br />~/A,~l/rz4¢.~,¢~ Alter: [] Relocation: [] Otc. Chg.'. [] Review: [] <br /> <br />Height of Building: No, Stories: Sq, Ft, ;~nd Floor: <br />/Z;/ / <br />Mobile Home Occupancy; <br />Width: <br /> <br />Sq. Ft. Main Floor; <br /> <br />Mobile Home <br />Length: <br /> <br />Use of Building; RES <br /> <br />Sq, Ft, Garage: ] Other; <br />Occupant Load; 1 Water.~S/~pply: <br /> <br />Valuation; $. ~'~'f/¢ ~'~ <br /> <br />Proposed Septic Installation: <br />Previous Site Evaluation #: <br />Type of System: <br /> <br />Test Holes ReadyI <br />Will call when holes ready: <br /> <br />Existing Septic System: <br />Existing Tank Size; <br /> <br />Proposed Bedrooms; <br /> <br />_.~,x,!§tlng Orainfield Length_.'_ <br /> Type of B.~stem; <br /> <br />Date Tank Pumped: <br /> <br />Existing Bedrooms; <br /> <br /> ) I have read this application [n its entirety and certify th8t the stated information i8 <br /> true and correct to the best of my Imowledge, <br /> ) [ am performing wed( on a property I own or occupy. <br /> <br /> ~.-')" The work will be performed by e registered builder, <br /> ) Other <br /> <br /> the state of Oregon and the ordinances of Madoll County, <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL' <br /> <br />Bldg, Fee: $. <br /> <br /> Mobile Home Fee: <br /> Fleet Surcharge; '~'..~;' <br /> <br />Zoning Surcharge: <br />State Surcharge: ,~, <br />Plans Check Fee: ,..¢,~. ~¢._~ <br />Bite Evaluation Fee; <br />Septic Permit Fee; <br />DEQ Surcharge; <br />Technical Review Fee: <br />Reinspection Fee: .... <br />investigation Fee: <br />City Fee; <br />~TOTAL FEE: <br />RECEIPT NO,: <br /> <br /> <br />