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BUILDING [] <br />P~0 arty Owner <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />"City Setback Requirements <br />Front:: ,.~¢~..~'~ Rear <br /> <br />Left ., Right <br />ISide /~" Side <br /> <br /> genator Bldg,, NO,, 225 <br /> 220 High Street NE <br /> <br /> Phone $88-$147 <br /> <br />MOBILE HOME~' SEPTIC <br /> <br />PERMIT APPLICATION <br /> <br />Phone <br /> <br />Job Address <br /> <br />Subdivision <br /> <br />Mobile Home Perk <br /> <br />Section Township:: <br /> I <br />~ Lot De th:: <br /> <br />Range <br /> <br />Acres <br /> <br />Mailing Address ' <br /> <br />Site NO <br /> <br />Property Tax Lot No ~, <br /> <br />Let <br /> <br />Sp # <br /> / <br /> <br />Zone Map <br />Irreg/~ Co~:~ <br /> <br />Cross Street <br /> <br />'~leet S¢C Zone:: <br /> <br />Block <br /> <br />Total # Spaces:: ~ ~ <br /> <br />JJ;c ?'/4 cAntract°r Business/~4~ Y~'~'~ame and NO:: ~.~,.~4~ <br />Arc~itect~ Engineer , <br /> <br />Phone <br /> <br />de of Permit New ~' Addition [] Demo [] Teeh <br />~J~7£~l¢I~ Alter [] Relocation F'] Occ Chg:: [] Review <br /> <br />No Stories:: <br /> / <br /> <br />Mobile Home <br />Length:: ~ <br /> <br />Sq Fl, Main Floor:: Sq Ft 2nd Floor <br /># Bedrooms Occupancy:: <br /> <br />Height of Building <br /> <br />Mobile Home <br /> <br />Proposed Septic Installation <br /> Previous Site Evaluation # <br /> <br />Proposed Bedrooms <br /> <br />Type of System <br />Test Holes Read~( <br />Will call when holes ready <br /> <br />Address <br /> <br />Address:: <br /> <br /> Use of Building RES <br /> <br />,Sq Ft Garage:: iOther <br />Occupant Load:: Water S~pply:: <br /> <br /> Valuation ___ _. <br /> <br />Bldg Fee $ <br />Mobile Home Pea <br />Fleet Surcharge:: <br /> <br />Zoning Surcharge <br />State Suroharge ~ ,~-.~ <br />Plans Check Fee <br />Site Evaluation Fee <br />Septic Permit Fee:: <br />BEQ Surcharge <br />Technical Review Fee <br />Reinspection Fee:: <br />Investigation Fee <br />City Fee <br />TOTAL FEE:: J,/.,.~-'-~-¢ <br />RECEIPT NO ~7'~ ~ ¢ <br /> <br />Existing Septic System <br /> Ex_isting Tank Size <br /> Existing Drainfield Length <br /> <br /> Type Ct System <br /> Date Tank Pumped Existing Bedrooms <br /> <br />( V~I have read this application in Its entirety and certify that the statod information is <br /> true and correct to the best of my knowlodge <br />i t./~'.,,,P~'am performing work on a property I own or occupy <br />~ ~ I am 8 registered builder OR ( ) the authorized representative of a registered <br /> uilder <br /> <br />~ ,...,..)"'q-aCt oe to build according to the.~brnitted pJanm and speE~¢atlons, tho laws of <br />SIGNATURE OF APPLICANT ~i ~ ..... <br />OTHER PERMITB REQUIRED BY T~I~ Dli~T,: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br /> <br />