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ReceiYed 'By <br /> <br />City <br />Zoning Validation <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> Senator Bldg. NO. 225 <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone seE-s147 <br /> Code-A-Phone 4=30 RM, - 8;00 A.M. <br /> <br />Fr~ontOity Setback Requiremen~ts <br /> Rear <br /> <br />I Left R~'ght' <br />L Side Side <br /> <br /> BUILDING [] MOBILE HOME [] SEPTICt~ PERMIT APPLICATION <br />Property Owner;; .... ~ . [ Phone;; f¢;?~,'~ . -'[ M~iling ~dress:: <br /> <br />Property Tax Lot No, <br /> <br />Lot:: <br /> <br />Sp,, //,:: <br /> <br />Irreg Lot Corner <br /> <br /> Subdivision <br /> <br /> Mobile Home Park:: <br /> <br />"-Lot WidiSh r Lot Depth <br /> J <br /> <br />Fleet S/C Zone <br /> <br />Phone <br /> <br />Phone <br /> <br />Address <br /> <br />Address <br /> <br /> Type of Permit:: New E3 Addition:: [~ Demo:: [] Tach Use of Building <br /> ~).~1¢~~ ' I Alter '~ Relocation:: [] Ccc Chg:: [] Review:: [] <br />__ <br /> Height of B~ilding Bq Fl Main Floor:: Sq Ft 2nd ~loor Sq Ft Garage <br /> <br />Mobile Home <br />Width <br /> <br />lNo Stories <br /> <br /> Mobile Home <br /> Length:: <br /> <br />Bedrooms;; <br /> <br /> Proposed Septic Installation <br /> Previous Site Evaluation <br /> Typ~ Of System:; <br /> Test Holes Ready ~ l__ _.¢j <br /> Will call when holes ready <br /> <br /> Existing Septic System <br />_~.xisting Tank Size:: <br /> <br />Existing Drainfield Leng_th:: <br /> <br />Type of.,.S.~etem <br /> <br />Proposed Bedrooms <br /> <br />L_,,, ?ate Tank Pumped _ Existing Bedrooms, <br /> <br />b¢lder <br /> <br />Other <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT,: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev 12/87 <br /> <br />Occupant Load <br /> <br />Bldg Fee:: <br /> <br />Mobile Home Fee <br /> <br />Fleet Surcharge <br /> <br />Zoning Surcharge:: <br /> <br />State Surcharge <br /> <br />Plans Check Fee:: <br /> <br />Site Evaluation Fee <br />Septic Permit Fee <br />DEQ Sumharge __ <br />Technical Review Fee <br />Reinspection Fee <br />Investigation Fee <br />City Fee <br />TOTAL FEE <br />RECEIPT NO <br /> <br /> ~S <br /> .L_c_°2Z <br />" Other <br /> <br /> Water Supply <br /> <br /> <br />