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C y , ~_~[~ ' Se,atafBIdg. No. SSS / / I Rear. 2' '~' <br /> <br /> BU~I~'~ MOBILE HOME ~ SEPTIC ~ PERMIT APPLICATION ~' <br /> <br />Property Owner; <br /> <br />Job Address: <br /> ~'-ID <br /> <br />Subdivision'. ~1~ ,. <br />Mobile Home Park: D/,,~/~/"~ <br /> <br />Phone; <br /> <br /> Site No.: <br /> <br />Mailing Address: <br />z-/7¢ C/P/op, ¢2. <br /> <br />Pro~rty Tex 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 />Z~oo~.,~,~. Mep.~ <br />Irre~ Lot: Corner; <br /> <br />Contractor Business Name and No,; Phone: Address; <br /> <br />Type of Permit; New; <br /> <br />Alter: [] <br /> <br />Addition; [] Demo; [] Tach. Use of Building: RES <br />Relocation: [] Ccc. Chg.: [] Review: 6~ COM [] <br /> <br />Height of Buildlngl~ <br /> <br />Sg, Ft, Main Floor: Sq. Ft. 2nd Floor: Sq. Ft. <br /> <br />Mobile Home Mobile Home # Bedrooms: Occupancy: <br />Width: Length: <br /> <br />Valuation: <br /> <br /> Proposed Septic Installation: <br /> <br /> Type of System: ................................................ <br /> Test Holes Ready; <br /> Will call when holes ready: Proposed Bedrooms: <br /> <br /> ~;ta Tank Pumped'. --~ .-- ..... Exlstin~ Bedrooms', <br /> <br /> true and correct to the best of my kn~ledge, <br />( ) i am performin~ work on a property f own or occupy. <br />( ~ ) ~ am a registered builder OR ( ) the authorized representatl~ of a registered <br />(~) The work will be performed by a registered builder. <br /> <br />( ~ ) ~ agree to b,ild according to the submi~ed plans and specifications, the law8 of <br /> the state of Oregon and the ordlna~ of Marion County, <br /> <br />OTHER PERMITS REQUI~EBgkHIS DEP[: PLUMBING, EEE~g~idAL, <br />MC 15-6 <br /> <br />Bldg, Fee; <br /> <br />Mobile Home Fee'. <br />Fleet Surcharge: <br />Zoning Surcharge; <br />State Surcharge: <br />Plans Cheek 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 /> <br />