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Received ay MARION COUNTY BUI <br /> Salem~ Or~on 97301 <br /> <br /> J~Address <br /> <br />Mobile Home Park <br />Section <br /> <br />Lot Width <br /> <br />Lot Depth <br /> <br />Ra~2 -- <br />Acres Irre~ <br /> <br />Lot:: <br /> <br />Sp ~z <br /> <br />Map <br /> <br />Block <br /> <br />Total # Spaces:: <br /> <br />^r¢~itecb ~nginee~ <br /> <br />Type of Permit <br /> <br />Phone Address <br />Phone Address <br /> <br /> / <br />New:: ~ Addition:: [] Demo U Tach <br /> <br />LJ~e of Building:: <br /> <br />RES "~ <br /> <br />Height of Building <br /> <br />Mobile Home <br />Width <br /> <br />Alter [~ Relocation ~ Ccc Oho [] <br /> <br />Mobile Home <br />Length <br /> <br />Sq Ft Main'FIoo~ <br /> <br /># Bedrooms <br /> <br />Review [] <br /> <br />Sq Ft 2nd Floor:: <br /> <br />Occupancy <br /> <br />Occupant Load <br /> <br />Valuation <br /> <br />COM [] <br /> <br />Supply <br /> <br />./ <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 ready <br />Existing Septic System;: <br />Existing Tank Size <br />Exie?_~ Dralnfield Length <br />Type of System:: <br /> <br />Proposed Bedrooms <br /> <br />Date Tank Pumped <br /> <br />Existing Bedrooms <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT,;: PLUMBING, MECHANICAL, ELECTRICAL <br />MC; ~5-6 <br />Rev tO/87 <br /> <br />Bldg 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 />Reinspection Fee <br />Investigation Fee <br />City Fee:: <br /> <br />TOTAL FEE <br />RECEIPT NO <br /> <br /> <br />