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City I ~"(' [~ ~ ~= ~¥] ~ ARION C~OUNTYs,,.atorBUILDINGs~ag, No,, 225 INSPECTION <br />ZoningL~'~!~.~Ja'ion - ~ 220 High Stre~ NE Front <br /> :~ ,.:,1 ',~. ) Salem Omg°n 973~ Left <br />Date Phone 588-5147 Side <br /> <br /> ~U[LD[N~ I~~ MOBILE HOME ~ SEPTIC ~MIT APPLICATION <br /> <br />City Setback Requirements <br /> Rear <br /> <br /> Right <br /> Side <br /> <br />Property Owner <br /> <br />Job Address ~ <br /> <br />Subdivision Lot <br />M~b~ Home Park:: Sp, ¢ <br /> <br />Lot Width I Lot Oepth ~Acres ~r Irreg Lot m <br /> <br />Phone I Mailing Address <br /> Site Ne:: <br /> <br />Cross Street <br /> <br />Property Tax Lot No:: Fleet SFC Zone <br /> <br />Map:: <br /> <br />Block <br /> <br />Total ~ Spaces <br /> <br />~~_, _~,~/~..C°ntract°¢ Business Name and No <br /> <br />Phone <br /> <br />Phone:: <br /> <br />rase <br /> <br />Type of Permit:: <br /> <br />Mobile Home <br />Width <br /> <br />Alter <br /> <br />~ Addition:: [] Demo:: [] Tach <br />I-J Relocation:: [] Ccc Chg [] Review:: [] <br /> <br /> No Stories:: [ Sq Ft Main Floor Sq Ft 2nd Floor <br /> <br /> Mobile Home ,¢ Bedrooms Occupancy <br /> Length ,/7,/ <br /> <br />Proposed Septic Installation <br />Previous Site EvafuaPon # <br /> <br />Type of System <br />Test Holes Read7 <br />Will call when holes ready Pro,.p, oaed Bedrooms <br /> <br />Existing Septic System <br /> Exist!ng Tank Size <br /> Existing Drainfield Length:: <br /> <br />Type ¢_f System <br />Date Tank Pumped ___ Existing Bedrooms <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT,:: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Use of Building <br /> <br />Sq Ft Garage <br />Occupant Load <br /> <br />. Other <br /> Water Supply <br /> <br />Valuation <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 />Reinspection Fee <br />Investigation Fee <br />City Fee <br /> <br />TOTAL FEE:; <br />RECEIPT NO <br /> <br /> <br />