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BUILDING [] <br /> <br />MARION COUNTY BUILDING INSPECTION c[-~-y Setback R~e.c{uiremen,,,~s_' <br />2,20 High Street NE t:: ~¢' Rear: <br />Salem, Oregon g~el <br /> <br /> ~OBILE HOaE ~EPTiC, ~ PER~IT APPLICATION <br /> <br /> ~ Site ~,,;; <br /> J ~rty T~ ~ No Fleet S/O ZO e <br /> <br />Mobile Home Park', ~,,,,~_ <br />Lot Width:: Acree: I~reg LO'k <br /> <br />Use of I~uild%g <br /> <br />Sq Fi Garage Other' <br />Occupant Load:; <br /> <br />RES <br /> <br />eOM [~ <br /> <br />Proposed Septic Installation <br /> Previous Site Evaluation ¢~;: <br /> <br />Type ef Systemt <br />Test HOles Ready~ <br />'Will call when holes ready;: Proposed Bedrooms, ~ , ",,,' <br />~X~ Septic Sy~rn <br />..... Exia~ng Tank Size: <br /> <br /> Existin~ Oralnfidid I. eo~t,h.. <br />_T~y~pe 414 System <br /> Date Tank Pumped4'"~ ~, <br /> <br />VaJuatidn <br /> <br />$1d~l, Fee' <br /> <br /> Fleet Surchs,~e <br /> Zoning Surohaa'Ae <br /> State Surcharge; <br /> Plans Check Fee <br /> <br />. Site BA~alu§ti, on Fee <br /> <br /> DEQ Surcharge <br /> Technical Review Fee' <br /> ~einspeotJ~ Fee <br /> investigation Fee" <br /> City Fee <br /> <br /> TOTAL F~ <br /> RECBPT NO <br /> <br />,5", <br /> <br /> <br />