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MARION COUNTY <br />'~" - ~/-~ DEPT. OF BUILDING INSPECTION <br /> <br /> Appl. Revd; ~F~D, · Senator Building # 225 <br /> 220 High St., N.E. 2nd Floor Permit No, <br /> Salem, Oregon 97301 <br /> By: ,,~g:,¥L, R.H. WITHROW, BLDG. ADMINISTRATOR~ By: <br /> $88-514Z - 588-5148 <br /> 4-3.6-80 5:00 P,M.- ........... CODE-A-Phone 588-5373 ........... 8:00 A.M. ~ <br /> Date: Date: <br /> <br />Owner: -- <br /> <br /> KILROYS MO. HO. <br />Bldr. a No.: ' '~:4905 <br /> <br />Type of Pbrmit: ~iOBILE HOM~ REPLACE, MENT a ELECTRICAL_: ~CT%O~ax Lot No; <br />Address: 5932 ~L~'~GE VI~ ~. S.E. ~ ~e. /~, Twnshp. <br /> 363~8347 ~ame <br /> Phone: ~ <br /> Phone:~ Address: .... <br /> <br />Plans by; F~hone: Address; <br /> M~p~,~aeJ e ..~nk Zone Chg. ParT. Coed. Use I Variance I Fire Zone Occupancy <br /> <br />Lot No: BIE. No: Sub dy. . Lot Size ~.5 AC Corner? <br /> <br />Type of Const, <br /> Rear <br /> <br />Water Supply: W;~LL Valuation: . $ <br />Sewage ......... N~ Site .- <br />· ~^J_~'~ u~ ~EPTIC Evah <br />O~sposah , Permit Fee: <br /> <br /> No, <br />Area of 91dg: 14 ;< ?0 Stories: State Surcharge; <br /> Roof <br />Basement: Type: Plans Chk, Fee: <br />Heating <br />System: Septic Permit Fee; <br /> <br />35.00 <br /> <br /> 1.40 <br /> <br />BTU: ,,, ' <br /> <br />Total Fees: 36.40 <br /> <br />VALIDATIONS: <br />ZONING SEPTIC~~ PLANS "~,~ l <br /> <br />/ agree to build accord/nD re ~e cubmitted plans and ~p~if/cations, ~e /a~ of ~e S~te of Or, on and the Or/dnances of Marion <br />County_ Permit explre~ if work not ~mmenced within 120 days. I furhter expressly warrant d)gt I comply with the provisions of ORS <br />701.005 ~o 701.125 because: <br /> <br />( ) I a~ a r~istered builder or ( ) the au thor/z~ repre~ntat/ve of a r~/ster~ builder <br />( ) The work will be pe~ormed by a r~istered builder <br />( / /amperform/n~rkonaproper~lownoroccu~y <br />( ) Other (p/ease ~ec/fy) <br /> <br />REMARKS: <br /> <br />EXISTING SEPTIC: UNKNOWN DRAINFIELD: i~NY, NOWN PREVIOUS BE, DROOMS: 3 <br /> <br />I have read this eppl/catlon in /ts entirety and certify that the stated information /s true and correct to the best of my knowledge. <br /> <br /> PL/~ASE NOTE: Driveway and sidewalk inspections are required (I~F Publlc Works: 588-5036 <br /> Other permits required by this dept: Plumbing [] Electrical E~ <br /> <br /> <br />