Laserfiche WebLink
Cdy, g .... ' // ~ / F~eer / <br /> <br /> ...... .~ ,, ~ <br /> <br /> Property Owner / ~ Phona Mailing ~, ~ ~ ,. ~J_~ <br /> <br /> Job Address ~ ~. A Site No ~ Cross Street / <br /> .................. ......... <br /> ~ ~¢-- ~ ,/ ~ ~. ¢ P~perty Tax Lot No ~ Fleet S C~e <br /> .................... ;../ <br /> <br />Mobile Home PArk <br /> <br />Section <br /> <br />Lot W~dth <br /> <br />Tow*ship '"~--7 Re.ge <br /> <br /> l? _L <br /> <br />Sp <br /> <br />Total Cf Spaces:: <br /> <br />[rreg Lot ~orner <br /> <br />Architect-~Er~]'~'~ / I Phone <br /> r'--~_~..~ ~ ...... 1- <br /> <br /> Type of Permit I New ~ Addition:: <br />,~.j..~,.~,f.~.[ Alter:: [] Relocation:; b~ Ccc Chg:: [] <br /> <br />Height of Build,~ng <br /> <br />Mobile Home <br />Width <br /> <br />Proposed Septic Installation, <br />Previous Site ~valuatJon #:: <br /> <br /> Type ~ System <br /> 'Test Holes Read',,( <br /> Will call when holes ready Proposed Bedrooms [ <br /> Existing Septic System <br /> E×istin(l Tank Size <br /> E_xiSting Drainfield _L.,~_ngth;: /, L~' ~' ' <br /> <br /> Type of Syatem ¢~ _~,~,. ~'; ( ~ - <br /> Date'~ank P.umPed:: -~ y~'~' Existing Sedrooms::~. <br /> <br />( .¢-- ~ ~r/yave read this application in it. entir~y and certify that the statod i~formation is <br />f ~/~lr~e~ ;;OrfCorOrmriOn~ 'w°otrhkeobne;tp:fopr~¥rt~:°oWwlendo~reoccup¥ <br />f ~ I am e registered buiidor OR { ) the authorized represontative of a registered <br /> builder <br />( J e wot w' be e, rfor~o by a r gistered b~ der , <br /> <br />f ~/~ lagrootobudda¢¢ording o hesubrn edpansandspeo <br /> the state of Oregon arid ~h8 ordinance8 ~f Marion County <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPI': PLUMBING, MECHANICAL, ElECTRiCAL <br /> <br />Address <br /> <br />Address <br /> <br /> Use of Building <br /> <br />Rev,ew:: [] <br /> <br />Valuation:: <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 />