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D~te ¢7- t- 9/ <br /> <br />Pro~erty Owner <br />~eb ~ddress <br /> <br />MARION COUNTY BUILDIN <br /> Senator Bldg,, No 225 <br /> <br /> r Phone -- Mailin~-;~ <br /> Site NO Cross <br /> <br />Property Tax Lot No.,J <br /> <br />Sp # <br /> <br />Map <br /> <br />Fleet SiC Zone <br /> <br />Block <br /> <br />-:Total #, Spaces <br /> <br />tCgntr~ctor Business Name and NO ~¢~O ~ <br /> , , / <br /> Architect/Engineer <br /> <br />~'ype of,Permit <br /> <br />'~4eight of Building -- <br /> <br /> Mobile Home <br /> width ' <br /> <br />Phone:; Address <br />//¢?- q7¢ /,¢,4/7 <br />Phone Address <br /> <br />New ~ Addition:: L~ Demo:: [] Tach <br />Alter [] Relocation:: ~ Ccc Chg [] Review:: [] <br /> <br />No Stories <br /> <br />Mobile Home <br />Length ~¢ <br /> <br />Sq~:24~Ft Main Floor ' Sq Ft 2nd Floor <br /># SedroolYls Occupancy:; <br /> <br />~/~'f~¢~-Use of Building'r~_/~,,C~.t _~, CoMRES ~ <br /> <br />Sq Ft Garage <br />Occupant Load <br /> <br />Proposed Septic Installation <br />PreviOus Site Evaluation ¢:: <br />Type of ~¢vstem <br />Test Holes Ready <br />Will call when holes ready Proposed Bedrooms' <br /> <br />Existing Septic System <br /> Existing Tank Size <br /> Existing ~rainfield Length:; <br /> <br />_ Type of System <br /> Date Tank Pumped:: Existing Bedrooms <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT4 PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 <br />Rev 12/87 <br /> <br /> _- Other:: <br /> War. ply:: <br />Valuation $~. ~ <br /> <br />Mobile Home Fee <br /> <br />Reef Surcharge <br /> <br />Zoning Surcharge <br /> <br />State Surcharge <br /> <br />Pla~s Check Fee <br /> <br />Site Evaluation Fee:: <br /> <br />Septic Permit Fee <br /> <br />DEQ Surcharge <br /> <br />Technical Rewew Fee <br /> <br />Reinspection Fee <br /> <br />Investigation Fee: <br /> <br />City Fee <br /> <br />TOTAL FEE <br /> <br /> <br />