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BUILDING [] <br /> <br />,Job Address <br /> <br />MARION COUNTY B~IN,G ,IN,~ECTJOI~I_ICity 8City Setback Requ,rements Senator BI <br /> <br /> Salem, 0r~730~ <br /> <br /> Phone ....... <br /> <br /> ~{ I ~ Site No Cross Street <br /> <br />Subdivision <br /> <br />Mobile Home Park <br /> <br /> .Fb ' J ...... <br /> <br />Property Tax Lot No <br /> <br />Sp # <br /> <br />- Map <br /> <br />Fleet $/C Zone <br />Block <br /> <br />qogtra~;r-~u~i~ I~r~a-~'~-N~] ...... ~-~ 'f Phone <br />Architect Engineer Phone <br /> <br />T pe of Permit ~New I~:¢" Addition [] <br />,/~;~ i ~,~. Alter [3 Relocation [] <br /> <br /> Height of Building No Stories <br /> <br /> Mobile Home Mobile ~omo <br /> Width ~ <br /> <br />Demo U Tach <br /> <br />CCC Ohg :: [] Review:: <br /> <br />Sq ft Main Floor <br /># Sed~oe~$: <br /> <br /> Use of Building <br /> <br />Sq Ft 2nd Floor Sq Ft Garage <br />Occupancy Occupant Load <br /> <br />Proposed Septic Installation <br />Previous Site Evaluation #:: <br /> <br />Type of System <br /> <br />Test Holes Ready <br /> <br />Will call when holes re~dy <br />Existing Septic System <br />Existing Tank Size <br /> <br />Proposed Bedrooms:: <br /> <br />Existing Drainfield Length <br />Type of System <br /> <br /> Date Tank Pumped ..... Existing Bedrooms:: <br /> ~lt I have road th~s application in its entirety and certtfy that the St ate(~ ~nformetton is <br /> true and correct to the best of my knowledgo <br /> <br /> builde~ <br /> <br />OTHER PERMITS REQ[J~:IED BY THIS DEPT: PLUMBING, MECHANICAL, ELECTRICAL <br /> <br />Bldg Fee <br /> <br />Mobile Home Fee <br />Fleet Sumharge <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 />Reinspection Fee <br />investigation Fee <br />City Fee <br /> <br />TOTAL FEE <br />RECEIPT NO <br /> <br /> RES <br />~ /~_ SCM ~ <br />Other:: <br /> <br />115':5-6 <br /> <br /> <br />