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Appl, Revd:: ~ <br />By: del <br /> <br /> MARMON COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building # ;]25 <br /> 220 High St., NE 2ndFIoor <br /> Salem, Oregon 97301 <br /> R.H. WITHROW, BLDG. ADMINISTRATOR <br /> 588-5147 - 588-5148 <br />P.M- ........... CODE-A-Phone 588-5373 ........... 8::00 A.M <br /> <br />/i <br /> <br />Type of Permit;; <br /> <br /> & br~infield <br />~¢;~>~,ic_ T~,nk Replr'_cement <br /> <br />9263 Porter ~osds,,,,o,~,i;. <br /> <br />Phone;: <br /> <br />Phone;; <br /> <br />~tumsvi! le <br /> <br />Address: <br /> <br />Address: <br /> <br />Address:: <br /> <br />Address;: <br /> <br />Owner:: 7r::nce~ i~i%linger <br /> <br />Bldr.& No ' <br /> <br />Plans by: <br /> <br />Phone: <br /> <br />749-2605 <br /> <br />.Tax Lot No; <br /> <br />Sec. 1 Twnshp,, <br /> <br />8 Rge 2W <br /> <br /> / <br />51 EFU <br />Use of Bldg,' N[N~ Bdrm~ <br />:qe?Eic ~ ~rainfi,;ld ~eT>~!ce~=~ <br /> <br />Va¢iance <br /> <br />Lot NO;; Blk,, NO: Sub dy. <br /> <br />Lot Size ~ ,.~Cre ~ Corner? <br /> <br />Water Supply: ~.'~tl <br />Sewage Site <br />Disposal:: ,-~ ;~-~ ~ Evah <br /> No, <br />Area of Bldg: Stories;;. <br /> Roof <br />Basement; Type: <br />Heating <br />System; <br /> <br />BTU:; <br /> <br />Valuation: $ <br />Permit Fee;; <br /> <br />State Surcharge; <br /> <br />Plans Chk, Fee: <br /> <br />Septic Permit Fee; <br /> <br />Total Fees:: <br /> <br />Rcpt. No;; <br /> <br />40.00 <br /> <br />40~00 <br /> <br />VALIDATIONS: <br />ZONING SEPTIC PLANS <br /> <br />By- By:: ~//~k¢' - ~-~ ~,..,z..~ i <br />Oate O~e ~ ~ ~ t Date:: <br /> <br />I agree to build ~cording to the submitted plans and ~pecifiCations, the laws of the State of Oregon ~nd the Oridnances of <br />County, Permit expires if work ~mmenced w~thin 120 days. I furhter expressly warrant that I comply w~th the provisions o~ QRS <br />701, ~ to 701 12~ because,: <br />( ) lamaregister~builderor( ) theauthorizedrepresentativeofar~ister~budder <br />( ) The work will be performed by a regi~ter~ builder <br />( ) I am performing ~rk on a proper~ I own or occupy <br />( ) Other (please ~ify] <br /> <br /> septic system is inadequate. <br /> <br />/ /lave read this application il~ /ts entirety and certify that the stated ihformatlon is true and correct to the best of my know/edge <br /> <br />SIGNATURE OF APPLICANT:: <br /> PLEASE NOTE:; Dry" ps ections~e required by Public Works;; <br /> Other permits required by this dept; Plumbing [] Electrical <br /> <br />588-5036 <br /> <br /> <br />