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City <br />Zoning Validation '~,¢¢ <br /> <br />Date <br /> <br />BUILDING [~OBILE HOME [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> Senator Ble~l. No,, 225 <br /> <br /> SEPTIC [] <br /> <br /> , Owner <br /> <br />Job Address <br /> <br />Subdivision <br /> <br />Phone <br /> <br />Site No <br /> <br />Property Tax Lot NO <br /> <br />Lot <br /> <br />City Setback Requirement~s <br /> <br />Front jC2 /' Rear <br /> <br />Left Right <br />Side /(-') Side:: <br /> <br /> PERMIT APPLICATION <br /> <br />Mailing Address <br /> <br /> Cross Street <br /> <br /> Fleet S/C ;*one:: <br /> <br />Block:: <br /> <br />Mobile Home Park <br /> <br /> Township <br />Se~i~.T -- <br /> <br />~Ot ~i~ / Lot Depth <br /> <br /> Sp #:: Total ,¢ Spaces <br />E,r/,~¢es / <br /> Map <br /> <br />Ran~./_.~ Zone:: ~,~. <br />Acres Ir%t <br /> <br />- C(~tjactor Business Nsn~e and No :: <br />Architect/Engineer:: <br /> <br />Phone;: <br /> <br />Phone <br /> <br />Address <br /> <br />Address:: <br /> <br />T pc of Permit <br /> <br />Height of Building <br /> <br />Mobile Home <br />Width:: <br /> <br />New ~' Addition ~ Demo [] Tach <br /> <br />Alter I-I Relocation [] Ocs Chg ¢~ Review [] <br /> <br />No Stories <br /> / <br /> <br />Mobile Home <br />Length <br /> <br />Sq Ft Main Floor <br /> <br />Bedrooms <br /> <br />Sq Ft 2nd Floor;: <br /> <br />Occupancy <br /> <br />Use of Building:: I RES <br />~ -~ Ot~er <br /> <br />Proposed Septic Installation <br /> Previous Site Evaluation ¢ <br /> T~pe Of System <br /> <br />Test Holes Ree,d,_y_ <br />Will salt when holes read.~_: <br /> <br />Existing Septic System <br />__.Existing Tank Size:: <br /> Existing Drainfield Length' <br /> <br />, Type of S. ystem <br /> <br />Proposed Bedrooms <br /> <br /> Date Tank Pumped Existing Bedrooms <br /> <br />~"~ ~amaregi..teredbuilderORt heau 0 Zed epesentatveofareoistered <br /> <br />Valuation' <br /> <br />Bldg, Fee <br /> <br />Mobile Home Fee <br />Fleet Sursharge:: <br />Zoning Surcharge <br />State Sumharge <br />Plans Cheek Fee;: <br />Site Evaluation Fee <br />Septic Permit Fee <br />DEQ Surcharge <br />Technical Review Fee <br /> <br />SISNATURE Of APPLICANT ~ ~ <br />OTHER PERMITS REQUIRED BY THI~ DEP~: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Reinspection Fee <br /> <br />Investigation Fee:: <br /> <br />City Fee:: <br /> <br />TOTAL FEE <br /> <br />RECEIPT NO <br /> <br />~_ 37.~0 __ <br /> <br /> <br />