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Zoning Validation; ~ ~.~ ~ ~2oHIgh~tr~NE <br />Date; ~.'~ ,~(~ ~ ~.,.~ '~, ~.~ *'~ Salem, Oregon 97,0, <br /> <br /> r City Setback Rgqyirem,.e.~n_ts~ <br /> l ront: ¢¢r .ear'. ,5/ <br /> F~'et~ ~.-/i Right C'- / <br /> <br />UILDINO~ ~~E ~ SEPTIC ~PERMIT APPLICATION <br /> <br />Job Address: <br /> <br />Mobile Home Park: <br /> ...~-----~-~_ <br /> <br />LO~ Width~ ' I Eot Depth: Acres: <br /> <br />Site No.; <br /> <br />Pro erty Tax Lot No,; <br /> <br />Lot: <br /> <br /> Sp. :¢: <br /> <br />rreg. LOt: Corner: <br /> <br />Fleet S/tC ~ne; <br />Block; 6.[ <br /> <br />Total ¢ Spaces: <br /> <br />Phone: <br /> <br />Phone: <br /> <br />'~/ge of Permit: ] New; [] Additlon; [] <br />· -~-~'5~ / A er' [] elocution' <br /> <br /> Height ~f Build,g; ~ No. Stories: ...... Sq, Ft. Main Floor: <br /> ~ile Home~ / J Mobile ~ome ~ 'l ~ Badrooms; <br /> <br /> Previous ~lt~ Evaluation <br /> Ty~e of System: <br /> ~est Holes <br /> Will call when holes <br /> <br />Demo: [] Tach. <br /> [] Review; [] <br /> <br />Sq. Ft. 2nd Floor; <br />Occu p~,~cy: <br /> <br /> Proposed Bedrooms: <br /> Existln,~ Tank Size: .. ~g~-O ¢tt~ I <br /> Existing Dralnf(eld Length: j.. OQ {~"/ <br /> <br /> Date Tank Pymped: Existina Bedroo~- ~ <br /> <br /> Thewot witl~epefo edby g~teed ulldor,,l~ <br /> <br />OTHER PBRMIT~ REOUIRBD BY TNI8 DEPT,: P~UM~IN8, MECHANICAL, <br /> <br />Rev. 1~/87 <br /> <br /> , / ,,,: ....... <br />Occupant. Load; Water Supply: <br /> <br /> Valuation; $ <br /> <br />Bldg, Fee; <br /> <br />Mobile Home Fee: <br />Fleet Sumharge; <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 <br /> <br /> <br />