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--- <br /> E <br /> D <br /> . , 6,;; Marion n county <br /> OREGON <br /> iiiPUBLIC WORKS <br /> N. <br /> (504-486-5036 <br /> mARmN COUNTY BUILDING INSFECITON <br /> BOAR °F DECLARATION OF PRIMARY HOME OWNERSHIP <br /> -COMIIIISSIOPIERS. <br /> tern Mk <br /> Sanl Brentano The dwell-mg permit and%or septic permit,being applied for at this address.::, <br /> ' euin,camer:B► <br /> 0( L\ N\a.).0CA is for a dwelling that is-my <br /> DiRECroit <br /> Wan RE:. <br /> P residence for the major Of each calendar <br /> ADMINIS RAT1tIN <br /> Square footage ofexistii 1prev nu dwel g: I.` ` <br /> BUILDING <br /> INSPECTION #of existing : 3 #ofexiSting Bathrooniar <br /> EMERGENCY <br /> MANAGEMENT Square fo. ge of existing/previous a±ta t--i <br /> ENGVrtol+lG I am.providing as proof of prmar} residency a <br /> of one#.f.the folTuvikng <br /> documents: <br /> EPARRONMENTAL <br /> SERVJCES: A Driver's licens- <br /> ❑ Property tax r .,.•° <br /> .OPERitrtotis ❑ Utility bill <br /> PARKS ❑ Bank or credit card SIZIMO <br /> ❑ Pay stab <br /> PLANNING ❑ Voter registratio card <br /> ❑ Other <br /> IIMPirf <br /> I hereby declare that he above statements and evidence pnwided is true to the <br /> best of cry.knowledge and belief,:and that I tang` .d •:it is snbjeet:to,penalty for <br /> perjury; <br /> Name-OgkIN f /114 W-LAJ/V( i: <br /> Date: /JU r/ 4 dam: <br /> Phone#; 50 86 7. 7 _3 <br /> 5155 Sliver-tort Road NE'«-Salem,cE9 305-3802. wvo•Lca.marion:eras W <br /> Printed.crrrecycleapaper• Rea`uee:-Reuse-Recycle-Recover <br />