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588-5147 - 588-5148 <br /> _22_ 0 00P.M.. ........... CODE-A-Phone <br />Date; Date:· <br /> <br />Address: ............. 9864 Mill Creek Rd. , AumsvSlle Rte. <br /> <br />Owner: <br /> <br />f{amuel T. Smith <br /> <br />Bldr. & No ' <br /> <br />Plans b¥~ <br /> <br />u~,,of ~L~..%' - ' '" <br /> <br />Zone Chg. <br /> <br /> Phone: Address: <br /> <br /> I <br /> M in Req, Front Sides Rear <br /> oN°~"dr 'm'::rueD- t.o ~r~ Setbacks;' <br /> <br />Lot No: 81k. No: Sub dv. <br /> <br />Water Supply: Valuation: $ <br /> <br />Sewage sei~t±c Site <br />Disposal: Eval: Permit Fee; <br /> <br /> No. <br />Area of Sldg; Stories: ........ State Surcharge; <br /> Roof <br />Basement: Type; Plans Chk. Fee: <br />Heating ,~dequnc~ Check <br />System; Septic Permit Fee; <br /> <br />13TU; ......... Total Fees; <br /> Rept, No: <br /> <br />Lot Size .... ~,orner. __ <br /> <br />2[~ · O0 <br /> <br />VALIDATIONS: <br />ZONING.0 S E PTI C T~,~ PLANS <br /> <br />I agree to bul/d accordi~ to De submltt~ plan$ and sp~ifications, De la~ of the $~te of Or, on and the Or/dnance$ of Marion <br />County. Permit expires if ~rk not commenced within 120 day~. I forhter expressly warrant that I comply with the provisions of ORS <br />701.~5 to 701.125 beDaUb: <br /> <br />( ) lamaregi$teredbuHderor( ) ~eauthorlz~representativeofar~/$ter~bu//der <br />( ) The work w/ii be pe~orm~ by a registered builder <br />( ) / am performing ~rk on ~ prope~y I own or occupy <br />( ) Other (please $p~ify) <br /> <br />REMARKS; ............ <br /> <br />Location of septic tank and drainfield,$n unknown. S~m ~ 11~'~I't~11~ <br /> <br />There are two pr,op~t~.9~_~with the ~ addr~l~ 6 ~re~ ar.d I is !./~-~ <br />these are not the same. <br /> / have read th/s app//catbn in /ts entirety and Deft/fy that the stgt~ information /s true and correc: to the best of my knowl~ge, <br /> <br /> PLEASE NOTE: Driveway a~d sidewalk inspections are required by Public Works: 588-5036 <br /> Other permits required by this dept: Plumbing ~ Electrical ~ <br /> <br /> <br />