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BUILDING [] <br />Properly Owner <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> Senator BIdilk No, ~ <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />MOBILE HOME [] SEPTIC [] <br /> <br />SuJ:~tl¥ision <br /> <br />Property Tax Lot NO <br /> <br />Lot <br /> <br />Sp- #' <br /> <br />Zone: Map <br /> <br /> PERMIT APPLICATION <br /> <br />Ma~lm§ Address: <br /> <br /> Cross Street- <br /> <br /> Fleet S/C Zone <br /> <br />BlOOk- <br /> <br />Tota~ 4* Seases- <br /> <br />Lot Width LO[ Depth <br /> 150 ~4~o '__ <br /> <br />I~e~ Lot- Comer: <br /> <br />Phone <br /> <br />I=hone <br /> <br />Type Of Permit I~ Addifi'on [] .... Demo: <br /> <br />Height of Bu40i~' o Stor~s ~ FI Main FIo~- <br /> <br />"'Tach .... <br /> Review, <br /> <br />Scl. Ft 2nd Floor,, <br /> <br />Use df Building- <br /> <br />SO Ft, Garage <br /> <br />Occupant Load <br /> <br />RES ~l <br /> <br />COM ID <br /> <br />~;&t~ su~:~ <br /> <br />Proposed Sepbc Installation <br />Previous Site ~,v'aluation /,, <br /> <br />T P~.~_System <br /> <br />Existing Septic System <br />Exis~.. Tank Size <br /> <br />,_Proposed Bedtoor/~. <br /> <br />Extsling Dram~field Length.__ __ <br />Ty,.p~e~o t Sy3tem, <br /> <br /> Valuation. $ <br /> <br />Btdg Fee L <br />Mobile Home Fee. <br />F~eet Burcharge: <br />Zoning Surci~arge. <br />State Surcharge. <br />Plans Check Fee,, <br />Site Evaluation Fee <br />Septic Permit Fee' J ~'~ 0 ,,.4) O <br />DEQ S~roharge: __ ! O ~OC) <br />TeGhnical ¢~e.view Fee- <br />Reinspeotlo~ Fee. <br />tnYe~BgatiOn Fee: <br />Gity Fee <br />TOTAL FEE <br />RECEIPT NO" <br /> <br /> / / <br />OTHER PERMITS REQUIRED BY 'THIS I;llEp'r.; PLUM/I~ING, MECHANICAL, ELECTRICAL <br />MC t,~,,6 ~ <br /> <br /> <br />