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I? <br /> <br />Received ?y; ....... <br /> <br />Bubdivision; <br /> <br />Mobile Home Perk: <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> Senator 81rig, No, 220 <br /> <br />Date; Phone $88-$14T <br /> Code-A-Phone 4:30 RM, - 8;00 A,M. <br /> <br /> BUILDING [] MOBILE HOME .,[~., ~SEPTIC [] <br /> Prop.rty Owner; Phon~ <br /> <br /> Job Address: Site No.; <br /> ~[~ ~ ~ ~7~0~ Property Tax Lot No,: <br /> <br />Bp, ¢; <br /> <br />City Setback Requirements: <br /> <br />Front; Rear: <br /> <br />Left Right <br />Sde: .Sde: <br /> <br /> PERMIT APPLICATION <br /> <br />Mailing Address: <br /> <br /> C~.~ Street: ~ <br /> Fleet S/C Zone: <br /> <br /> Block; <br /> <br />Total ¢ Spaces; <br /> <br />Section: Township: <br /> <br />Lot Width; Lot Depth; <br /> -/Q ......... I0 0 <br /> <br />Range: <br /> <br />Irreg. Lot: <br /> <br />Map: <br /> <br />Contractor Business Name and NO.: <br />Architect/Engineer; <br /> <br />Phone; <br /> <br />Phone: <br /> <br />Address; <br /> <br />Address; <br /> <br />Type of Permit: I Now; ¢'~ Addition: [] Demo: [] Tach. <br />g'~L(~/ J Alter: [] Relocation: ~] Ccc. Chg.: [] Review: [] <br />Height o~r Building: <br /> <br />NO, St~ls: <br /> <br />Sq. Ft. 2nd Floor: <br /> <br />Mobile Home Mobile Home # B~cirooms: Occupancy: Occupant Load; <br />Width; Length; <br /> <br />Use of Building; RES <br /> <br />~ ~EC~arag,; Other; <br /> Water Supply: <br /> <br />Proposed Septic Inotallation: <br />Previous Bite Evaluation #; <br /> <br />..... Type of System; <br /> <br />Test Holes Read.,yj, <br />Will cell when holes ready: <br /> <br />Existing Septic System; <br />Existing Tank Size; <br /> <br />Proposed Bedrooms: <br /> <br />Existtn9 Orainfiold Length: <br /> <br />l'~pe....of System: <br /> <br />Oete Tank Pumped: .... <br /> <br />Existing Bedrooms; <br /> <br /> (~) Ih8veroadthisapplieationinit~entiretyandcerttfythattheetatedinformationi$ <br /> ( ~ ) ~ am pedofrntng work on a property I own or occupy. <br /> <br /> The work will be performed by a registered b¢lder, <br /> Other <br />(~/~) I agree to build according to the subrnided plans and specifications, the laws of <br /> the s~ate of Oregon and the ordinances of Marion County. <br /> <br />OTHE. R PERMITS REQUIRED BY THIS DEPT,: PLUMBING, MECHANICAL, E ~I~C.'FRICAL <br />MC 15-6 ,e <br /> <br />Mobile Nome Fee: <br />Fleet Surcharge: } ~ ~-(~ <br />Zoning S~rcherge; ~, 5 % <br />State Surcharge: D 3 -% '~ <br /> <br />Site E~luation Fee: ......... <br /> <br />DEQ Surchargs: <br /> <br />City Fee', <br /> <br />~EOEIPT NO.'. <br /> <br /> <br />