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City ~-~ <br />Zoning ValidationS'7"-', · ' ' <br /> <br />BUILDING [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> Senator Bldg. NO. 225 <br /> 220 High Street NE <br /> Salem, O~gon 97301 <br /> <br /> Phone 589-s147 <br /> Code-A-Phone 4:30 EM. - 8:00 A.M, <br /> <br /> MOBILE HOME [] SEPTIC~ <br /> <br /> i ity 8,~,!,beck Requirements.: <br /> ront: '2. (7 Rear: ~-~ <br /> L~ ....... /~g~i' ..... <br /> Side' ~ / Side' ~- <br /> <br />PERMIT APPLICATION <br /> <br />-Propert Owner: jj Phone: Mailing Address: ~'v ~ /~ f ~'~'~" <br /> <br /> Jeb s Site No.', /'2-~-0'o Cross Street: <br /> Property Tax Lot NO.: Fleet S/C :'one; <br /> Subdivision: Lot: Block: <br /> Mobile Home Park: Sp. #: Total # Spaces: <br /> S o c t i o ~; ,._~.~.~.~.~.~.~.~.~_ Town s h~,~._~ Range: /'/ ~'~/ Zone:~_/ Map: <br /> <br /> Lot Width: Lot Depth; Acres; Irreg, Lot; Corner; <br /> ......... <br /> <br />Contractor Business Name end No,; Phone; Address: <br />Architect/Engineer: Phone; Address: <br /> <br />Type of Permit: New; '~ Addition: Ci Demo: [] Tach. Use of Building; <br /> <br /> Alter; <br /> Relocation: <br /> Ccc. <br /> Chg.: [] Review: [] ~ /4..-~ <br /> <br />Height of Building; <br /> <br />Mobile Home <br />Width; <br /> <br />No. Stories: Sq. Ft. Main Floor: Sg, Fi, 2nd Floor; <br /> <br />Mobile Home # Bedrooms: Occupancy: <br />Length; _ ~ <br /> <br />Proposed Septic Installation: <br /> Previous Site Evaluation #: <br /> Type of System: .~,~. ,,¢)_7~¢ <br /> Test Holes Reedy; <br /> <br />Will call when holes ready; Proposed <br />Existing Septic System; <br />Exls~¥g Tank Size: <br /> <br />Existing Drainfield Len~!~i <br />Type of System; <br /> <br />Date Tank Pumped: <br /> <br />Existing_S_e?qe.m_s/ <br /> <br />(__) I am performing work on a properly I own or occupy. <br /> <br />( ) The work Will bO performed by a registered builder, <br />( ) Other ..... <br />( ) [ agree to build according to the submdled plans and specifications, the I~w~ of <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev. 12/87 <br /> <br />Sq, Ft, Garage: <br />Occupant Load; <br /> <br /> RES <br /> COM <br /> <br />Other: <br /> <br />Water Supply: <br /> <br />Bldg, 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 />Retnspection Fee: <br />Investigation Fee: <br />City Fee: <br /> <br />TOTAL FEE: <br />RECEIPT NO,; <br /> <br />Valuation; <br /> <br /> <br />