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BUILDING [] <br /> <br />MARION COUNTY BIJ'I'J:~ING.~ ,S~.. E;C~IO ,i~ l~,~ty Setback Requirements: <br /> <br /> ~ Side; D I Side: <br /> <br />Property Owner; <br /> <br />/ <br /> <br />Phone: - ' Mailing Address: <br /> <br />Job Address: <br /> <br />Site NO.: <br /> <br />Property Tax Lot No.: <br /> <br />Cross Street: <br /> <br />Fleet S/C Zone: <br /> <br />Subdivision: Lot; Block; <br />Mobile Home Perk: Sp. ~: Total ~ Spaces: <br />~e~ion: Range: Map: <br /> <br />Lot Width: <br /> <br />Lot Depth: <br /> <br /> i Zone; <br /> <br />Acres: Irreg. Lot'. <br /> <br />Corner; <br /> <br />Phone; <br />q 'l- /zoo <br /> <br />Phone: <br /> <br />Type of Permit: //New; ~, Addition: [] Demo: [] Tach, <br />,~D'q"C~rT~--~FferlAIter; [] Relocation: [] Ccc, Chg,: [] Review; <br /> <br />Use of Building; <br /> <br />Height Of Building: No, Stories; Sq. FI, Main Floor; Sq. Ft. 2nd Floor; Sq. Ft. Garage; Other: <br /> <br />Mobile Home Mobile Home # Bedrooms; Occupancy: Occupant Load: <br />Width; Length: <br /> <br />Proposed Septic Installation: <br />Previous Site Evaluation ¢: <br /> <br />__~pe of System: <br /> Test Holes Reedy: <br /> Will call when holes ready; <br /> <br />_Pff~_posed Bedrooms: <br /> <br />..... Existing Bedrooms: <br /> <br /> Existing Septic Systemr <br /> Exlst~.g- Tank Size: <br />___E¢isfing Drainfield Len,,~_th; <br /> Type of Systen~ <br /> Date Tank Pumped: <br /> <br />Valuation <br /> <br /> t hove read this appliCation in its entirety and certify that the stated informagon is <br /> true and correct to the best of my knowledge. <br /> I am performing work on ~ property I own or occupy. <br /> I am 8 registered builder OR ( ) the authorized representative of e registered <br /> builder, <br /> The work will ce performed by a registered builder, <br /> Other__ <br /> I ~gree to build according to the ,~:¢t{itted plar¢ and sK~oificatiens, the laws of <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT,: PLUMBING, MECHANICAL, ELECTRICAL <br />Rev. Ig/67 <br /> <br />RES [] <br /> <br />COM CJ <br /> <br />Water Supply: <br /> L. rrV ..... <br /> $__ <br /> <br /> Bidg, Fee: <br /> <br />Mobile Home Fee: <br /> <br />Fleet Surcharge; <br /> <br />Zoning Surcharge; <br /> <br />State Surcharge'. <br /> <br />Plans Check Fee; <br /> <br />Site Eve, luation Fee: <br /> <br />Septic Permit Fee: <br /> <br />DEQ Surcharge: <br /> <br />Technical Review Fee: <br /> <br />Reinspecbon Fee; <br /> <br />Investigation Fee; <br /> <br />City Fee: <br /> <br />TOTAL FEE: <br /> <br />RECEIPT NO,; <br /> <br /> <br />