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Received By:: ~ <br />City ,~'~ ,/~ <br />Zonidg Validation ~ &¥', <br /> <br />Date- ~2. ~ - ';// <br /> <br />Senator ~ldg,, NO. 225 <br /> 220 .Igh <br />$atem, Oregon 973~ <br /> <br /> Phone 588-5147 <br /> <br />Requirements <br /> <br />Property Owner Phone <br /> <br />Job Address ' <br /> <br />Mobile Home Park <br />Se:iiod' Townshi~ <br />' Lot Dept~ <br /> <br />Site No <br /> <br />Property Tax Lot No <br /> <br />Block <br /> <br />Total ¢ Spacee <br /> <br />Correcter Business Nome and No:: <br /> <br />Phone <br /> <br />Phone:: <br /> <br />Address <br /> <br />- Ty, e of. Permit ~-New:: ~;,J,'~/ Addition:: L~ Demo:: <br /> <br /> MobileHeight of Home/~/Buildlng MobileN° Stories::/Home ~Sq Bedrooms/~Ft Main'Floor <br /> Width ~ / Length <br /> <br />[] Tech <br />[] Review <br /> <br />iSq Ft 2nd Floor <br />Occupancy <br /> <br />Proposed Septic Installation <br /> PreviOus Site Evaluation ¢/ <br /> Type of System:: <br /> <br />Test Holes Reod~ <br />Will call when holes ready <br /> <br />Proposed Bedrooms <br /> <br /> Existing Septic System <br /> Existing Tank Size <br /> Existing Drain!ield Length <br /> Type of System <br /> Date Tank Pumped Existing Bedrooms;: <br /> (~) iha~e ead th s application in its entirety and certify that the stated information ia <br /> true a~ld correct to the Pest of my knowledge <br /> I I am perform~n9 work on a proper~ own or occupy <br /> I I am a registered builder OR ~uthodzed representative of a registered <br /> <br /> ~The work will be performed by a registered builder <br /> <br />~HER PERMIY~ REQUIRED ~Y THIS DEPT.:: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Use of Suilding r RES <br /> COM [] <br /> <br />Sq Ft Garage <br /> <br />Occupant Load ,~ pply <br /> <br />Valuation <br /> <br />Bldg Fee $.__ <br />Mobile Home <br />Fleet Surcharge <br />Zoning Surcharge <br />Stere Surcharge <br />Plans Cheek Fee <br />S~te Evoluation Fee <br />Septic Permit Fee <br /> <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 />