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Recold/ed By; , <br /> <br />Cit~ <br />Zoning Validation: <br /> <br />Date: <br /> <br />BUILDING [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> Senator Bldg. NO. 225 <br /> 220 High Street NS <br /> Salem, Oregon 97301 <br /> <br /> Phone S88-5147 <br /> Code-A-Phone 4:30 P.M. - 8;00 A.M. <br /> MOBILE HOME [] SEPTIC'~ <br /> <br />City Setback Requirements: <br /> <br />Front: Rear; <br /> <br />Left Right <br />Side: Side; <br /> <br />PERMIT APPLICATION <br /> <br />Subdivision: <br /> <br />Mobile Home Park,. <br /> <br />Section: '1" Townehip; <br />Lot Width ......... Lo Dep~th <br /> <br />Phone: Mailing Address; <br /> ? 7 <br /> <br />Site NO.: <br /> <br />Property Tax Lot No,; <br /> <br />Lot: <br /> <br />Sp, <br /> <br />Zone; Map: <br />Irreg, Lot; Corner: <br /> <br />Cross Street: <br /> <br />Fleet SIC Zone: <br /> <br />Block: <br /> <br />Total # Spaces; <br /> <br />tContreofor Business Name and NO.:~ <br /> <br /> /Engineer: ' ~'~'~ ~'~-~- <br /> <br />Phone: <br /> <br />Phone: <br /> <br />Address; <br /> <br />Address; <br /> <br />Type Of Permit; <br /> <br />Height of Building: <br /> <br />Mobile Home <br />Width: <br /> <br />New: [] Addition: [] · Demo: <br />Alter: ~r, Relocation: [] O¢c. Chg.: <br /> ' No, Stories;/ Sq, .///~)(~Ft' Main Floor: <br /> <br /> Mobile Home :~ Bedrooms: <br /> Length; <br /> <br />[] Tach. <br />[] Review: <br /> <br />Sq, Ft, 2nd Floor; <br /> <br />Use of Building; <br /> <br />Sq, Ft. Garage: <br /> <br />Occupancy; Occupant Load: <br /> <br />Proposed Septic Installation: <br /> Previous Site Evaluation ~¢; <br /> Type of System: <br /> <br />Test Holes Ready; <br />Will call when holes ready', Proposed Bedrooms; <br />Existing Septic System: <br />Existing Tank Size: <br />Exlet!n~ Drainfield Length: <br />Type of System: <br />Date Tank Pumped; Existing~.B_e_?~o¢~s; <br /> <br />(~) I have read this application in its entkety and certify that the stated Ioformation is <br /> true and correct to the best of my knowledge. <br />?4 ) I am performing work on a property I own or occup~ <br />) [ am a registered builder OR ( ) tile authorized representative of e registered <br /> builder, <br />( ~ ) The work will be performed by a registered builder, <br />( ) Other <br />(/~ ) I agree to build according to the submieed plans and specifications, the laws of <br /> the state of Oregon and the ordinances of Marion County. ~.~ <br /> <br />SIGNATURE OF APPLICANT <br /> <br />OTHER PERMITS REQUIRED BY THIS DEPT.: PLUMBING, MECHANICAL, ELECTRICAL <br />MC 15-6 , _ RECEIPT <br /> <br />Valuation; $ <br /> <br />Bldg. Fee: $ <br />Mobile Home Fee: <br />Fleet Sumharge; <br />Zoning Surcharge: <br />State Surcharge; <br />Plans Cheek Fee; <br />Site Evaluation Fee'. <br />Septic Permit Fee: <br />DEQ Surcharge: <br />Technical Review Fee: <br /> <br />Reinspection Fee: <br /> <br />Investigation Fee: <br /> <br />City Fee: <br /> <br />TOTAL FEE; <br /> <br /> <br />