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Property Owner <br /> <br />Job Address::*' <br /> <br />MARION COUNTY BUILDII~N~'I~'~I~I ~I/71 ¢~y ~k .equirem;~ts <br /> <br /> Salem Oregon 97301 U~ T ~ ' "~ ~~ ~ ~ <br /> <br /> Crd~A-~hone 4'30 RM - 8"00 A <br /> ...... ~ARiON <br /> <br /> P~o~e. Mailin* AOdr~$ <br /> ~/ <br /> Sde Ne Cr~s Street ~"'- ~' <br /> <br />MObile Home Park <br /> <br />Section~:~ .-~ Town ~ ip:: <br />Lot Width Lot ~ih / I Aeree:: <br /> <br />Property Tax Lot No:: <br /> ¢~ ed- t Po <br /> <br />Lot ¢/ <br /> <br />Sp # <br /> <br />Irreg Lot:: <br /> <br />Fleet SiC Zone <br /> <br />Block <br /> <br />Total # Specee:: <br /> <br />Address ,~¢~7t <br />I Addreee ,- <br /> <br /> e of Permit:: New <br /> <br />Height of Building, -- .-.I Ne Stories:: <br />~ / Mobile Home <br /> <br />Addition [~ Demo:: [] Tach <br />Relocation:: [] Ccc Ohg [] Review:: [] <br /> <br />Sq Ft Main Floor <br /> <br />Sq Ft 2nd Floor:: <br /> <br />Occupancy:: <br /> <br />Use of Building <br /> <br /> l_ OOM <br /> <br />Sq Ft Garage <br /> <br />Occupant Load <br /> <br />Proposed Septic InstalfatiOr~:: <br /> Previous Site Evaluation # <br /> Type of System <br /> <br />Test Holes Ready <br /> <br />Will call when holes ready <br /> <br />Existing Septic System <br />Existing Tank Size <br /> <br />Proposed Bedrooms <br /> <br />Existing Drainfield Leng~, <br />Type of System <br /> <br />Date Tank Pure,peal <br /> <br />Exiatin9 Bedrooms:: <br /> <br />(I/-) ~ have read this application in its entirety and ced'lfy that the stated information is <br /> <br />((,~ lamaregisteredbuilderORt )thoautborizedrebresentativeofaregistered <br /> <br />t ~ The work ¢41f be performed by a registered builder <br />[ ) Other <br /> <br />t ~ [ agree to build according to the submitted plans and specifications the laws of <br /> <br />Other <br /> <br />OTHER PERMITS REQUIRED BY THIS DEP'r,: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev 12~87 <br /> <br />Valuation <br /> <br />Water Supply <br /> <br />BJdg Fee S- <br />Mobile Home Fee <br />~leet Suroh~rg~ <br /> <br />Zoning Surcharge <br />State Surcharge:: /, ~-,_4 ~-- <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 />TOTAL FEE:: ~'~ <br />RECEIPT NO <br /> <br /> <br />