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<br /> DEcEovED
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<br /> 1 Equine Facility Exemption Certification Z ���z
<br /> Marion Co 5 Silverton
<br /> on Rd.N l Salem Oregon
<br /> �7eGt.QI1 Division
<br /> , FEBMarttlt7 5155 Silverton Rd.NE Salem Oregon 97305 Vsomiot onVNgr,
<br /> County Phone: (503) 588-5147 Fax: (503) 588-7948 Email: building(a�co.mariori or.us� 1NSP or(ON
<br /> OREGON
<br /> Site Plan is Required-see attached information
<br /> Owner/applicant name: vl, ,1 kk, �S Phone: sqSq,Email:JD ri-Ir1i 1I►QS e 9rnC t.r
<br /> Mailing address: Q I LGt �1/N 4i City/State:,h�i1 ?-,�,� ©ice Zip: g73O3
<br /> 71a0 l is-�- f2
<br /> Job site address: a / (�� Zip: a1 736 3
<br /> City/State: �-
<br /> Parcel Information: Parcel Size: I off- Parcel No.: Zone:
<br /> Proposed Building Information
<br /> Describe specific use of the buildingand items contained within ►1 O Y 4- (S Si ?.-
<br /> P ��Lt-�- vL tiSL �/s
<br /> y
<br /> Building Data: Length: /�/2 Width:r;?9 7 Area: 3 6 0 Height: /eVi2
<br /> Type of Exemption: Pigricultural Building ❑Forestry Building ❑ Equine Facility(Provide information below):
<br /> What is the proposed maximum number of people(including employees, owners,etc.)that will be present in the building at
<br /> any one time?
<br /> Will this structure be used by the public at any time? oYes tNo
<br /> Is the proposed structure located within a floodplain? oYes flo
<br /> Is the building located on/used in the operation of a farm? oYes Niqo
<br /> Is the proposed structure a residential dwelling or manufactured home? oYes ,No
<br /> Is the use of the structure or the items within it used for any business or commercial activities? oYes o No
<br /> If yes,please explain:
<br /> No Agricultural/Equine Exemption Criteria-Select all that apply:
<br /> Storage,maintenance, or repair of machinery, equipment, and supplies used on this farm
<br /> ❑Raising,harvesting, or selling crops raised on this farm
<br /> ❑Feeding,breeding,management, or sale of livestock, poultry,furbearing animals, or honeybees
<br /> o Dairying or the sale of dairy products produced on this farm
<br /> o Other agricultural,horticultural, or animal husbandry used
<br /> 'Stabling,training,riding lessons, or clinics(Complete Equine Exemption Criteria)
<br /> #of stalls/horses q
<br /> # of stalls/horses for personal use only `if ,
<br /> # of stalls/horses used for commercial or trade purposes including boarding,training,rentals, clinics, shows, etc.
<br /> Which of the following systems will the proposed structure have?
<br /> Electrical es o No(Complete Electrical Wiring Criteria)
<br /> Will there be a concrete slab either within or adjacent to the building?..{;:x 41)
<br /> es k ' U
<br /> Will there be farm animals(poultry excluded)within the building at any time. ■ es X.ZTo
<br /> Will there be farm animals(poultry excluded)on the slab at any time? oYes
<br /> Will the building be used for storage of feed, hay, or straw? oYes No
<br /> Will the building be used for major repair of motor vehicle equipment? oYes No
<br /> Heating/cooling/ventilation/mechanical oYes No i-� i n
<br /> Septic 'es o No/(Any yes answer will require a se arate permit)
<br /> Plumbing(Please specify fixture type) E'es ❑No rlI(, Snit_,-to, \-Q F 5 v Sao e,r-
<br /> Pagelof5 how �jb5 (/
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