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BUILDING [] <br /> <br />MARION'COUNTY BUILDING INSPECTION <br /> Senator Blag,, NO,, 225 <br /> 220 High Stroet NE <br /> Salem, Oregon 97301 <br /> <br /> Phone S88~S147 <br /> Code-A-Phone 4:30 P,M. - 8:00 AM. <br /> MOBILE HOME [] SEPTIC [~ <br /> <br />Front:: ~-0 / Rear <br /> <br />PERMIT APPLICATION <br /> <br /> Property <br /> <br />-~Jo-b Address <br /> <br />Phone;: Mailing Address:: <br /> <br />Site NO <br /> <br />Subdivision <br /> <br />Mobile Home Park <br /> <br />Property Tax Lot No <br /> <br />Lot:: <br /> <br />Sp # <br /> <br />Cross Street <br /> <br />Fleet S/C Zone:: <br /> <br />Block <br /> <br />Total # Spaces <br /> <br />Section Township <br />Lot Width Lot Depth <br /> <br />Zone <br /> <br />Map;; <br /> <br />Corner j~) <br /> <br />Contractor Business Name end No <br /> <br />ArchitectrEngineer <br /> <br />Phone <br /> <br />Phone <br /> <br />Address <br /> <br />Address <br /> <br />Type of Permit New ~ Addition <br />~ t~'~'¢'~ ~,.-- Alter:: ~ Relocation <br /> <br />[] Demo [] <br /> <br />[] Ccc Chg:: [] <br /> <br />Tach <br /> <br />Review:; <br /> <br />Height of Building <br /> <br />Mobile Home <br />Width <br /> <br />NO Stoaee:: <br /> I <br /> <br />Mobile Home <br />Length <br /> <br />Sq Ft Main Floor:: <br /> <br />,¢ Bedroom~,~ <br /> <br />Sq Ft 2nd Floor:: <br />Occupancy <br /> <br />Proposed Septic Installation:: <br />Previos$ Site Evaluation # <br /> <br />Type of $~stem:: <br />Test Holes Ready <br /> <br />Will calf when holes ready <br /> <br /> Existing Septic System <br /> <br />.... Existing Tank Size <br /> Existing Drainfield Length <br /> <br />Type of System <br /> <br />Proposed Bedrooms <br /> <br />Date Tank Pumped <br /> <br />Existing Bedrooms <br /> <br /> Othor __ <br /> <br />:;%. P..M,.B "EO"'".¢"'__ ..,$ ..PT.= P'.M...G, M.C.*.,CA-, <br /> <br />Use of Building:: <br /> <br />~ Ft, Garage <br /> <br />Occupant Load <br /> <br /> Valuation <br /> <br /> Sldg 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 />RES ~ <br />COM [-- <br /> <br />Other <br /> <br />Water Supply:: <br /> <br />$ <br /> <br /> I/.. so <br /> <br /> <br />