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Mort <br /> <br /> Appl,, R'cvd, <br /> <br />Date:; 4/1=/76 <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> 3180 Ce~t~.~ St,,~N, E. <br /> Salem, Oregon 97301 <br />R.H. WITHROW, BLDG. ADMINISTRATOR <br />588-5147 -- 588-5148 <br /> <br />Permit Number/ <br /> <br />Bldg,, Permit:: Mobile home and septic Location Permit;; <br /> R%. / Box ~V~¢J ~]~e~ Aurora ~Sec. 21,4, l~city;; <br /> <br /> Konald ~. Jee 42 Willow Island, Canby 97013 <br />Owner:: Phone; 266-4512 Address: <br /> <br />Bldr,, & No,:: ~ <br /> <br />Phone; Address: <br /> <br />Plans by. Phone::_ Address:: <br /> 'I I <br />Use of Bldg :: Min Req,, Front ' Sides , Rear. <br /> Mobile home Setberk,:: ~; ~'~ ~ <br /> Sewage " o c Feas. ReC. ~ 1756 <br />Lot No:; BIk. No:: Water Supply:: ~/ell Disposal;; Se~ %i Study? 3,/2~/~ <br /> <br />Sub dy, Valuation: $ <br />Size of Lot.__ 4.5? ~S Corner?__ Permit Fee: <br /> <br />15.00 <br /> <br />Area of Bldg:: 3 bedrooms Plans Chk,, Fee:: ..... <br /> <br />No, of Stories:. State Surcharge:: <br /> <br /> 25.00 <br />Basement:: Septic Permit Fee; <br /> <br /> 40.00 <br />Type of Roof: Total Fees: <br /> Rept, No. <br /> <br />I agree to build accord/nB to the submitted/o,l~..~nd specifications, the laws of the State of Oregon and the Ordinance~ of Marion <br />County. Permit expires if work not eo~ypithin 120py~. ~ <br />SIGNATURE OF APPLICANT: ,-~-¢~/~/~'~'~¢"~'~'~ ' ~ <br />,. [ ~7 - ~,,/ ,' // <br />VALIDATIONS: / / ~ n/ / ~ <br />ZON,~ SEPTIC TANK~/~~ PLANS ,~ ~ <br /> / <br /> <br /> REMARKS <br /> <br />PLEASE NOTE: Driveway and sidewalk inspections are required by Public Works;; <br /> Other permits required by this dept; Plumbing [] <br /> <br />588-5036 <br /> <br /> <br />