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Received By: <br /> <br />City <br />Zoning Validation: <br /> <br />Date; <br /> <br />BUILDING [] <br /> <br />MARION COUNTY BUILDING INSPECTION <br />Senator Bldg. NO, 2;Zg <br />220 High Street NE <br /> Salem, Oregon 97801 <br /> <br /> Phone 888-5147 <br /> Code-A-Phone 4:30 P.M. - 8:00 A.M, <br /> <br /> MOBILE HOME [] SEPTIC [] <br /> <br />City Setback Requirements; <br /> <br /> Right <br /> Side: <br /> <br />PERMIT APPLICATION <br /> <br />Subdivieton; <br />Mobile Home Park; Total # Spaceg; <br /> <br />Section: <br />Lot Wi t~h: <br /> <br /> Township/~ Range; <br />, Lot Depth: ~___,~_~- <br /> <br />Phone; Mailing Address: <br /> <br /> Site No,; <br /> .l~p~ax LS!..~Io,; <br /> Lot; <br /> <br /> Sp, #; <br /> <br /> Irreg. Lot: [Comer: <br /> <br />Prose Street: <br /> <br />Fleet Sic Zone; <br /> <br />(~,rohit~c~/Enginee~ hone: Address: <br /> <br /> Type of Permit: Tach, Use of Suildlng: RES <br /> Review; [] COM [] <br /> <br />New; [~ Addition; [] Demo; [] <br />Alter; I~ Relocation; [] gcc, Chg,: [] <br /> <br />Height of Building: <br /> <br />Mobilo Rome <br />Width: <br /> <br />No, Stories: Sq, Ft, Main Floor; Sq. Ft. 2nd Floor; <br />Length:M°bile Zme # Be'~ddro~o~l'~ Occupancy: <br /> <br />Proposed Septic Installation; <br />Previous Bite Evaluation ~: <br />~.~'¥~@ of System: <br />Test Holes Ready: <br />Will call when holes ready; Proposed Bedrooms: <br /> <br /> Exieting Bedrooms; <br /> <br />i have read this applic~ion in its entirety and oerilfy that the stated information is <br />true and correm to the best of my knewledge. <br />I am performing work on a properly I own or occupy, <br />I am a registered builder OR ( ) the authorized representative of a registered <br />builder, <br />The work wilt be performed by a registered builder. <br />Other <br />I agree to build according to the submitted plans and speodl~attons, the laws of <br />the state of Oregon and the ordinances of Marion County, <br /> <br /> Existing Septic System: <br /> Exletin~ Tank Bize: <br />....... 6xieting Drainfield Len¢th.i' <br /> Type of System; <br /> Date Tank Pumped: <br /> <br />SIGNATURE OF APPLICANT: <br /> <br />OTHER PERMITS REQUIRED BY THIB DEPT,: PLUMBING, MECHANICAL, ELECTRICAL <br />MC <br />Rev. t2/87 ,, <br /> <br /> Sq. Ft. Gar. at.e; /Other; <br /> Oecupant/¢t~//LEd/"'~; j Water Supply: <br /> <br />Valuation: <br /> <br />Bidg, Fee: <br /> <br />Mobile Home Fee: <br />Fleet Surcharge: <br />Zoning Surcharge: <br />State Surcharge: <br />Plans Check Fee: <br />Site Evaluation Fee: <br />Septic Permit Fee: <br />DEQ Surcharge: <br />Technical Review Fee: <br />Reinepection Fee: <br />Investigation Fee'. <br />City Fee: <br /> <br />TOTAL FEE; <br />RECEIPT NO.: <br /> <br /> <br />