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Gity ,~ -/.y _ ~,L_,~,~ <br />Zoning Validation <br /> <br />Date:: <br /> <br />BUILDING [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> Senator Bidg,, NO,, 225 <br /> 220 High Stre~ NE <br /> Salem~ Oregon 97301 <br /> <br /> MOBILE HOME [~ SEPTIC [] <br /> <br /> ~itY Setback Requirements/ <br /> Front /~/ / IRear <br /> Left ~ I Rig;; <br /> <br />PERMIT APPLICATION <br /> <br />Property Owner <br /> <br />Job Address / <br /> <br />Subdivision <br /> <br />Mobile Home Park <br /> <br />Sec~5,,_ ! Towr~ <br /> <br />Range:: <br /> <br />Phone Mailing Address <br />Site No <br /> <br />Propert,y. Tax Lot o,:: <br /> <br />Lot:; <br /> <br />Lot Depth Acres <br />//,2, <br /> <br />Zon~ <br /> <br />Map;: <br /> <br />Corner/ <br /> <br />Cross Street:: <br /> <br />F set S/C Zone <br /> <br />Block:: <br /> <br />Total ¢ Spaced <br /> <br />Co tractor Business Name and I~, <br /> <br />Phone:: <br /> <br />Phone:: <br /> <br /> ype of ~ermit T New <br /> ~0~t I,,%¢ .Alter <br />Height of Building:: <br /> /// <br />Mobile Home <br /> <br />Addition <br /> <br />[] Relocation <br /> <br />No Stories <br /> / <br />Mobile Home <br />Length ¢~ <br /> <br />[] Demo <br /> <br />[] OccChg:: <br /> <br />Sq Ft Main Floor <br /> / <br /> <br />Proposed Septic Indtallation <br /> Previous Site Evaluation # <br /> Ty_E?..9!..S yste m <br /> Test Holes Ready:: <br /> Will call when holes rsad~_ Proposed Bedrooms <br /> <br />Existing Septic System:: <br /> Existing Tank Si_ze <br /> Exlst!n~ Orainfield Length <br /> <br />__ ,Type of System <br /> <br />Date Tank P_u_m. ppd, <br /> <br />Existing Bedrooms <br /> <br />{'~ I Save read this application in its entirety end certify th&t the stated information is <br /> true and correct to the be~t of my know~edge <br />t I am performing work on a property I own or occupy <br />~ Ii I am a reDistored builder OR t ~ the authorized representative of a registered <br /> builder <br />I ,,~ I 'l"be worff will be performed by a registered builder <br />t ) Other <br />~'f ) I agree to build according to the submitted plans and specifications, the laws of <br /> the state of Orego¢~ and the ordin nces o Marion Coun y <br /> <br /> SIGNATURE OF APPLICANT '~' <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.:: PLUMBING, MECHANICAL, ELECTRICAL <br />MC ~5-S <br />Rev 1~87 <br /> <br />Address <br />Address <br /> <br />Tach,, Use of Building:: <br />Review:: [] <br /> <br />Sq Ft 2nd Floor <br /> <br />Sq Ft Garage:: <br /> <br />Other:: <br /> <br />Occupancy Occupant Load <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 />· ~upply <br /> <br />RES <br /> <br />COM <br /> <br /> <br />