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Received ~,y; <br /> <br />City <br />Zoning Validation: <br /> <br />BUILDING [] <br /> <br />Property Owner; <br />~c:.c R~', ~ /c <br /> <br />City Setback Requirements: <br /> Rear: <br /> <br /> Right <br /> Side: <br /> <br />MARION COUNTY BUILDING INSPECTION E <br />Senator Bldg, NO, 225 <br />220 High Street NE Front: <br />Salem, Ot~on S7301 <br /> <br /> Phone 588-5147 / Side; <br /> L <br /> Code-A-Phone 4:,30 EM, - 8;00 A.M. <br /> <br /> MOBILE HOME [] SEPTIC [] PERMIT APPLICATION <br /> Phone:(~-;) ~,~-4-- ~4,J-0¢ J Moiling Address: ,1 ~ .~ ,+ -5' [' <br /> <br /> Site No,: Cross Street; <br /> <br /> Property Tax Lot No.: <br /> 7.2, Ioo - ooo <br /> Lot: Block; <br /> <br /> Bp, #; <br /> <br />Fleet S/C Zone: <br /> <br />Subdivision; <br />Mobile Home Park: Total # Spaces: <br /> <br />Section: <br /> <br />Zone: Map: <br />Irreg, Lot: Corner: <br /> <br />Lot Width; <br /> <br />Township: Range; <br /> <br />Lot Depth: ACreS; <br /> <br />Contractor Business Name and No.: Phone; Address: <br />Architect/Engineer: Phone; Address: <br /> <br />Type of Permit: New: [] Addition: [] Demo: [] Tach, <br /> Alter; ~ Relocation: [] Ccc, Chg,; [] Review: [] <br /> <br />Height of Buiidlng; <br /> <br />Mobile Home <br />Width: ~ <br /> <br />NO. Stories; <br /> <br />Mobile Home <br />Length: ¢__~ <br /> <br />Sq. Ft. Main Floor: <br /> <br />Sq, Ft, 2nd Floor; <br /> <br />Occupancy: <br /> <br />Use of Building: <br /> <br />Sq, Ft. Garage: <br /> <br />Occupant Load: <br /> <br />Other: <br /> <br />Water Supply: <br /> <br />Proposed Septic Instollatlon; <br /> Previous Site Evaluation #; <br /> Type~,Ol~ System: <br /> <br />?est Holes Ready: <br />Will call when holes ready: <br /> <br />Existing Septic System; <br />__~lsting Tank Size: <br /> <br />Proposed Bedrooms: <br /> <br />Existing. Drainfield Length: <br />__Type of System: <br />Date Tank Pumped: Existing Bedrooms: <br /> <br />OTHER PERMITS REQUIRER BY THIS DEPT,: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev, 12/87 <br /> <br />Valuation; <br /> <br />Bldg. Fee; <br /> <br />Mobile Home Fee: <br />Fleet Surcharge: <br />Zoning Surcharge: <br />State Surcharge: <br />Plans Cheek 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 />