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Zoning Validation ~ ..... <br />Date ~ -/~;~ - ~ j <br /> <br /> BUILDING [] <br />P~Owner <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> Senato¢ 81dg. No, 225 <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 5S8-5147 <br /> <br /> Phons Mailing Address <br /> <br />Job Address <br /> <br />SubdiviSiOn <br /> <br />_?.~ty .~et back Requ,rements:: J <br /> /~// Rear )~ 1 <br /> /¢~ Side:: /42 <br /> <br />PERMIT APPLICATION <br /> <br />Cross Street..¢¢,~ , <br /> <br />Property Tax Lot No: Fleet S¢C Zone <br /> <br />LOt / Block <br /> <br />Mob'le Home Park:: <br /> <br />Lot Width <br /> Z <br /> <br />Town <br /> <br />Lot Depth <br /> <br />Map <br /> <br />Total # Spaces <br /> <br />] A~hitect Engineer <br /> <br />Phons <br /> <br />Type of Permit:: New ~ Addition:: [] Demo [~ <br />~/,~t~,~./~e~/ Alter:: Eq Relocation;: i~ Occ Chg L~ <br /> <br />--R~-~i Of'l~uildi~-g NO Stories Sq Ft Main Floor <br />/g' 'g / i1 2.o ' <br />-M~-I~le Florae Mobile Home cf Bedrooms <br />Width .~6¢ Length:: .z.~) .~ <br /> <br /> ......... Z .............. <br />Address:: J <br /> <br /> Tesh <br /> <br /> Review [] <br /> <br />Sq Pt 2n~ ~10~: <br />Occupancy <br /> <br /> Proposed Septic Installation:: <br /> Previous Site Evaluation cf <br /> Type of System <br /> Test Holes Ready:: <br /> Will call when holes ready Proposed Bedrooms <br /> Existing Septic System <br /> _~Ex!_Stin~ Tank Size:: <br /> Existing Drainfield Length:: <br /> Type of System <br /> Date Te?k___P?mped Extstin9 Bedrooms <br /> <br /> ii have read this ~pcIlcadot~ in Its entirety and certify that the stated information is ~rue and correct to the best of my knowledge <br /> ) I am performin9 work on a property I own or occupy <br /> V(- I am a regmtered builder OR ( ) the authorized representative of a registered <br /> uilder <br />( L~ The work will be performed by a registered builder <br /> tho otc. to of Oregon and the rdy/ncc, Of 7ado, ecu?~ <br />SIGNATURE OF~ APPLICANT ~..~4' / J ~~ <br />OTHER PERMITS REQUIRED BY THI~ DEI~T.:: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Use of Building . J RES []~ / <br /> Ieom :i <br />Sq Ft Garage Other <br /> <br /> Valuation i&~r ¢ ~- ~ <br /> <br /> Bldg Fee:: $ <br /> Mobile Home Fee J"¢~¢'~- ~ <br /> Fleet Surcharge:: <br /> <br />Zoning Surcharge <br />State Surcharge .--~'~ .~" <br />Plans Check Fee <br />Site Evaluation Fee <br />Septic Permit Fee:: <br />DEQ Surcharge <br />Teshnieal Review Fee <br />Reinspection Fee .... <br /> <br />investigation Fee:: <br />City Fee ~'~*c~ S~ <br />TOTAL FEE /'-/~, ~"c~ <br />RECEIPT NO __ _'~'"].7 __¢~___ <br /> <br /> <br />