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city <br />Zoning Validation . ,, <br /> <br />Property Owner <br />Job Address:: <br /> <br />Subdivision <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> Senator Bldg. NO. ¢'29 <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> ..... Phone 588-5147 <br /> Code-A. Phone 4;;30 RM. - 8:00 A.M. <br />BUILDING ~OBILE HOME ~ SEPTIC ~ <br /> <br />Sectio~ ' [ Town~'hip I Range <br /> <br />Lot Width I Lot Depth Acres <br /> _,2s- ' [ <br /> <br />City Setback Req~,i.remen~ts i <br /> Front //__) Rear ~.(~ <br /> <br /> Side ~ Side / ¢ <br /> <br />PERMIT APPLICATION <br /> <br />Mailing Address . -- <br /> Cross Stree>/_/~ <br /> <br />Property Tax Lot NO/ <br /> <br />Lot:: <br /> <br />Sp # <br /> <br />Cor <br /> <br />Lot <br /> <br />F eat S/C Zone:: <br /> <br />Block <br /> <br />Total # Spaces:: <br /> <br />Phone:: <br /> <br />Phone <br /> <br />Address:: <br /> ¢3' <br /> <br />Address <br /> <br />~Y~..L, -:TY e of Permit New [[~7'/~Addition E~ Demo [] Tach ' <br />Height of Building <br /> <br />Use of Building <br /> <br />Sq Ft Garage:: <br /> <br />Occupant Load <br /> <br />Valuation <br /> <br /> RES <br /> COM <br /> <br />Other <br /> <br />Water Supply <br /> <br />No Stories:: ~ Sq Ft Main FIo~r / Sq Ft 2nd Floor <br />/ <br />Mobile Home 4* Bedrooms Occupancy;: <br />Length <br /> <br />Mobile Home <br />Width:: <br /> <br />Proposed Septic installation <br />Previous Site Evaluation #:: <br />_Type of System <br />Test Holes Rea,dy <br />Will call when holes ready .P.r,~o¢oeed Bedrooms:: <br />Existing Septic System:: <br />__E×?in9 Tank Size <br />Ex!~bng Drainfield Length <br />Type of _S..~'stem <br />Date Tank P~mped Existin¢] Bedrooms <br /> <br />( ,~d/,/lhav~r~ad~hi~a~p~i¢~ti~ir~itsenbretyand¢~r~f~thatthe~ta~ed~nf~¢ma~i~nis <br /> <br /> I/~11 ;~r;e~; build according to ~ubmitled piano a~-d ~/pe¢iSgaSon$. tho la~o of <br /> <br /> BIdg 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 />Reinspegtion Fee <br />Investigation Fee <br />City Fee:: <br /> <br />TOTAL FEE <br />RECEIPT NO <br /> <br /> <br />