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· .; Reee~4C~d ,By: <br /> <br /> Zoning Validation'· <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> ,','Senator B~dg. NO. 225 <br /> ;220 High Street NE <br /> Salem~ Oregoi3 97301 <br /> <br /> Phone $$e-5147 <br /> <br /> Code-A-Phone 4:30 P.M, - 8;ag A,M. <br />MOBILE HOME [] <br /> <br />Phone: <br /> <br /> City Setback Requirements; <br /> <br />SEPTIC [~;3EFIMIT APPLICATION <br /> Mailing Address; <br /> <br />Subdivision: <br /> <br />Mobile Home Park: <br /> <br />Section; Townih~ <br />~'~T-dth; Lot Depth; <br /> <br />Range: f'" [ Zonal ..... <br /> <br />AC ~'~ ...... v',, ~' Irreg. Lot: <br /> <br />Site No.: Cross Street: <br />Property Tax Lo~ No.: Fleet S/C Zone: <br /> <br /> Total # Spaces; <br /> <br />Map: <br /> <br />Corner; <br /> <br />Phone: <br /> <br />Address; <br /> <br />Architect/Engineer; Phone; Address: <br />Use of Building: <br /> <br />~'ge of Pern)it: . J New; ~;~ Addition; [] Demo: [] Tach. <br /> J~ Alter; [~ Relocation: [~ Ccc, Chg,; [] Review: [] <br /> <br />Height of Building; <br /> <br />Mobile Home <br /> <br />No, Stories; <br /> <br />Mobile Home <br /> <br />Sq, Ft, Main Floor: <br /> <br />Sq. Ft. 2nd Floor: <br /> <br />Sq. Ft. Garage; <br /> <br />Occupant Load; <br /> <br /> RES <br /> COM <br /> <br />Other; <br /> <br />Water Supply: <br /> <br />Width; Length: <br /> <br />Proposed Septic Installation; <br /> Previous Site Evaluation Cf'. <br /> Type of System; <br /> <br />_T?_st, ,H.~]~, Ready: k.~ <br />Will call when holes ready,~ <br /> <br />Ex/sting Septic System: <br />_ Exlstlng,,Taok Size; <br /> <br />Proposed Bedrooms; <br /> <br />Existing Drainfield <br />Type of System; <br /> <br />Date Tank Pumped: <br /> <br />(,.,~¢) ~ have reed this application in its entirety and certify that the stated information is <br /> <br />OTHER PERMITS REQUIRED 8Y THIS BEPT,: PLUMBING, MECHANICAL, ELECTRICAL <br />MC ~5-6 <br />Rev. t~/87 <br /> <br />Valuation: <br /> <br />Sldg, Fee; <br /> <br />Mobile Home Fee: <br />Fleet Surcharge: <br />Zoning Surcharge: <br />State Surcharge; <br />Plans Check Fee: <br />Site Evaluation <br />Septic Permit Fee; <br /> <br />Technical Review Fee; <br /> <br />Reinspeotion Fee: <br /> <br />Investigation Fee; / <br />City Fee: _ <br /> <br />TOTAL FEE: ~.. <br /> <br />RECEIPT NO,: <br /> <br /> <br />