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ReceiPed By ti~,~i(~(~uI~BUILDING INSPECTION <br />City ~ ~ ~20 High S~eet NE <br /> <br /> BUiLDiNG~L0~O¢I~~ SEPTIC ~ <br /> <br /> 854-3764 ~. q_, 3ox ~63 <br /> <br />Ci~?tback R.~equire_ments <br /> <br /> Left ,. Right <br /> <br />PERMIT APPLICATION <br /> <br />~Tr~p~r ty Owner <br /> Bob Layman <br /> -J~b Address ,~_..~.,~,.~E:~¢~i~,¢"~ ~. <br /> Detroit, OR 97342 Property Tax Lot NO <br /> 67o57-887 <br /> · -got <br /> Subdivision Patto~ Addl~lon -- ~ <br /> Mobile Homo Park Sp ~I <br /> <br /> 2 5E CG <br /> Lot Width L~ 6~pth ~ t "~ Acres kreg Lot:: <br /> 2 ' <br /> <br />Cro~S Street <br /> <br /> :leer' Si~ Zone <br /> <br />--Total cf Spaces <br /> <br />cbie Outdoor Advertising 1-686-8400 <br />^rchitect~EnSmeer ~'~ <br />cb&e 0u~door Advert±s±ng <br /> <br />Map <br /> <br /> Address <br /> P.O. Box 1356, Eus_ene, 0R.97440 <br /> / Add;~s-~ 1356 g ~uge~e ~ _ 97440_~ <br /> <br />Type of Permit:: / New:: ['~ Addition [] Demo [] Tach <br />Si ~ ~ ~ Alter ~) Relocation [~ Oct Chg [] Review <br /> <br />Height of ~d~l~,'~CJ ¢~1 ~-~ NO Stories ~ gt ~oi- S~ Ft 2nd Moor <br /> <br /> W~dth _- Length - - - - <br /> <br />Use of BuiMing~ ] RES ~ <br />Outdoor Advertisi.~gCOM ~ <br />SG Ft Garage Other <br /> -- <br /> val ti - 00-- <br /> <br />Proposed Septic Ir~stellatien <br />Previous Site Evaluation <br /> <br />Type of Systat0: <br />Test Holes Ready <br /> <br />when holes reedy Proposed I~edrooms <br /> <br />Existing Septic System <br /> Existing Tank Size <br /> Existing gr~inticld Len_sth: <br /> <br />T,~p¢ ot SyStem <br /> <br />Date Tank Pumped:: <br /> <br />Existing Bedrooms <br /> <br />BIdg Fee $ <br /> <br />Mobile Home Fee <br /> 8.96 <br /> <br />Zoning Surcharge .... <br /> <br />State Surcharge -- <br /> .6.5o <br />Plans C~eck Fee <br /> <br /> Site Evaluation Fee - <br /> Septic Permit Fee <br /> DEQ Surcharge <br /> Technical Review Fee ---. <br /> Reinspection Fee <br /> <br /> City Fee ~__. 00 .... <br /> TOTAL FEE <br /> RECEIPT NO <br /> <br /> <br />