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<br /> PITIPTNd DIS#ECTi001:487,010 ' :-Zoning by
<br /> 4155.S 'i,etton-Rd,ikit MAY 1.0 2023
<br /> :Fee
<br /> Salem.OR 9.7-3115' . .
<br /> .( 93)588•51141. Fax.:($113):$88.M.48 Rikdititl. MARION COUNTY
<br /> Activity:# .WILDING INSPECTION
<br /> •www.coanariomoriuS/PW/BnildindinSneetinit '
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<br /> Existing Facili Proposed Facility Water Supply:
<br /> Els,.ittle Family Residence r-i:: .L....1•Single Family Residence El Ptililic
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<br /> D. Site Evaluation El Renewal Permit 0Antltotiliation'Notice Mr:
<br /> E[ Construction Permit p.retniiiskeinstateraeht El Replacing a Dwelling
<br /> [:1! Repair Permit 0 Permit Transfer '0 The Addition of One or More Bedrooms
<br /> 0 Major El Minor lEi Existing SyStem Eyaluation-, 0 Personal lUard,siliff
<br /> 0: AlterationPermit EJ. Record Review CI Temporary Housing
<br /> 0 Major' II:. Minor ‘Otiwi• jitt—te\t--, - s: JO Connecting to SY.§erq:SevPr14 14e.
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<br /> 0 Other-PleaseSp.ecify
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<br /> tithe tequieedfee and elltadinielits,aa not includ4wiih thisapplicafion,.;.-itwiltboreiume4.:toyou.as ilncompkte.
<br /> Post the orange::card at.ihe entraneeto the.propeity. Flag the test holes.
<br /> By my signature,Ltertitr that the informatiodlhaye:furnished is.correct,end hereby grant Mation,COnnty,anthori4ed agent of the
<br /> Department'OtEnyironmenral Quality,permission to.egtor ori,tp,th4::Aniii.0-deiOiti3OsrprOjettr'fortO 001045,144:6$0.of t.lj'.$-nppikAtiOri:
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<br /> Signature- Date:. 'CCB# (if applicable)
<br /> APPtiearit•is the DON'iter .-W,- UthOrfied ReprOsOntatiVO f&Airtildrizatitinta &nil:iittaehed:
<br /> :. Apply
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