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AppL Revd; <br />By; T,~,, <br />Date: 6-11-80- <br /> <br />Type of Permit; <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> . Senator 13uiid[ng ~225 <br /> 220 High St., N.E. 2nd Floor <br /> Salem, Oregon 97301 <br />R,H. WITHROW, BLDG. ADMINISTRATOR <br />588-5147 -- 588-5148 <br />5:00 P.M.- .......... CODE-A-Phone 588-5373 ......... 8:00 A,M. <br /> <br />_Tax Lot Nm <br /> <br />By:~ <br />Date &-//',SO <br /> <br />Address: ~©~ V~, ~'~, ~Lz~,~ VIP.}! Cq~ "~3~.%~' AT~f,~TT,T,~, <br /> <br />Sec. Twnshp. Rge. ., <br /> <br />Owner: '"lI'['T,Z,cd"[ R !:fOL-~NG~3~ <br /> <br />Phone: ~-~LF? Address: <br /> <br />Bldr. & No.: SO~A~ i{~;¥ Phone: <br /> ..... ~ OP!i,I~ ;,i~ -',i',:.~; 1,~~ <br />Plans by: phone: <br /> <br />Address: <br /> <br />Address: <br /> <br /> Map page Zone Zone Chg, Part, Canal, Use I Variance Fire Zone j Occupancy Type of Co~st, <br /> <br /> er Oc~- Ld~ Min Req, Front Rear <br />Use of J~ldg.: NO Bd~m~, Setbacks; Sides <br /> <br />Lot No: , Blk. No: Sub dy. <br /> <br />Water Supply: Valuation; . <br /> <br />Sewage Site <br />Disposal; Evah Permit Fee: <br /> No. <br />Area of Btdg; Stories: .... State Surcharge; <br /> Roof <br />Basement; Type: Plans Chk, Fee: <br />Heating <br />System: Septic Permit Fee: <br /> <br />BTU: ..... / <br /> <br />Lot Size Corner? <br /> 11. <br /> <br />Total Fees: ...... 1J ·/+lf .... <br />Rcpt. No; '~ 7,~w''~' <br /> <br />VALIDATIO NS: <br />ZONING SEPTIC TANK PLANS ~ <br />Date: Data: Date: - , <br /> <br />/ a~/*e~ to bul~ ~l~ to th~ ~ub~,;~t~ plans ~ s~lfl~t~s, t~ /~ of ~e ~t~te of O~e~n ~ the OW~n~es <br />County. Petmi~ cxplres if worR not commenc~ within ~0 day~. I (~rhter expressly wbrr~nt that I comply w/th the provi~ions <br />~01.~5 to 701.12~ ~cause: <br />( ) I am a register~ builder or ( ) the au thorJz~ repre~n~ative of a r~i~ter~ builden <br />( ) The ~rk will be p~dormed by a reglster~ builder <br />( ) lamperformi~wo~ko~aprope~lownoroccupy <br /> <br /> / <br /> <br />I hgve read this application in its entirety and certify that the s~eted information is true and correct to the best of my knowledge. <br />SIGNATURE OF AppliCANT: )J'~.~-~, ~_~ <br /> PLEASE NOTE: Driveway and sidewalk inspections are r~qulred by Public Works: 588-5036 <br /> Other permits required by this dept: Plumbing [] Electrical [] <br /> <br /> <br />