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MARION COUNTY BUILDING INSPECTION <br /> SEPTIC [~ <br /> <br />BUILDING [] MOBILE HOME [] <br /> <br />PERMIT APPLICATION <br /> <br />Job Addre$~ / <br /> <br /> ' "'--/"'~' ~ite No,, CrOss Street <br /> <br />t ~,.~ ]~ ~.~ -~ Cc ~ ~ Property Tax LOt No- Fl?et S,~ Zeno <br /> ....~ Lot Block,, ' <br /> <br />Sp ¢ <br /> <br />Total # Spaces <br /> <br />tA ~r I~amecs Name and No <br /> rchitect I:~'~glne~r <br /> <br />...... Phone <br /> Phone: <br /> <br />Type Of Permit -~"~ ~=~' Addition <br /> j Altar [] Relocation <br />' H~ Of Building I No Stories <br />Mobil~ N'~me I Mobile Home <br />Width Length <br /> <br />[~ Demo [] Teeh <br />[] OtC. (~hg [] Review. <br /> <br /> -[ <br />tSq. FI,, Main F~oor' Sq Ft. 2nd Floor <br /> ~ Bedrooms. ~upa~ <br /> <br />Use of I~ildtng <br /> <br />Sq Ici Garage <br /> <br />OCCupant Load <br /> <br /> RES <br /> CC, M <br /> <br />SupPly" -- <br /> <br />Valuation $ .......... <br /> <br />___Previous Site Evaluatt~ # <br /> <br /> Type of System <br /> <br /> Teat Hole~ Ready <br />---7¢Vi1'~ c"~iJ when holes read~ <br /> <br /> Existi~nk Size <br /> <br />. - Exis~ ~rainflel¢ Len¢~ ....... <br />~ of 8ystem~ <br /> <br />Date Tank Pumped," .. <br /> <br />__ Existing Bedrooms. _l <br /> <br /> j Other <br /> <br />OTHER PERMITS REQUIRED BY THI~ DEPT,: PLUMBING, MECHANICAL, ELECTR~AL <br /> <br />Bldg,, Fee. L <br />Mobde Home Fee <br />Fleet Surcharge <br />ZOning StJrcherge <br />State Surcharge- <br />Plane Check Fee <br />Site I;;v~iuatlon Fee <br />~epiic Permit Fee <br />D~O Surcharge <br />Technical Review Fee <br />ReinspectiOCt Fee <br />)Ovestigation Fee <br />City Fee' <br />TOTAL <br />RECEIPT NO <br /> <br /> <br />