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': Appl. Revd:: Mond~ <br /> <br /> By: <br /> <br /> Date: <br /> <br /> MARION COUNTY <br /> DEPT. OF BUILDING INSPECTION <br /> Senator Building # 225 <br /> 220 High St., N,E, ?-nd Floor <br /> Salem, Oregon 97301 <br />R.H. WITHROW, BLDG. ADMINISTRATOR <br />588-5147 -- 588-5148 <br />5::00 P,M.- .......... CODE-A-Phone 588.53?3 ........... 8::00 A,M <br /> <br />Type of Permit: ~:-t~p includin~ o£fic~; ~zld gar~:~.~e <br /> 21371 Dieckman Lane~, $. E. <br />Address; ~!qP q).~,?-~ i~e~; ~.=~ Aumsville <br /> <br />Tax Lot No; <br /> <br />Sec. t,~ Twnshp,, ~ Rge ]-'~ <br /> <br />Owner:: ~ .n~.~ .m , ~;~ Con :rol DistriO~hone:: 769-2669 Address: <br />81dr. & No.: Mil{~ Adam~ ~ ¢' ~ ~'/~-~ <br /> ~on~ ~. Phone: ?~9-~9~ .... Address: <br /> <br />115 N'. Sectond <br /> <br /> SLayton Ore,on ./p ~> <br />3].0 :.¢sst Virsinia Gt:}ytoh <br /> <br />Plans by: Truns T Const. <br /> M~p Page ~ Zone Zone Chg, <br /> 60 J <br /> <br />Use of J~ldg,:: <br /> <br /> shop <br /> <br />Phone: 981_9.581 Address: 2100 bT, Pncific <br /> <br />Lot NO:: __BJk, No; <br /> <br />Sub dy. -- Lot Size Corner? <br /> <br />Water Supply;: <br /> <br />Sewage ~-.. ,, ' <br />Disposal,'~ -¢/ <br /> <br />Area of Bldg; ...... pO × ~0 <br /> <br />Heating <br />System;; <br /> <br /> Eval: <br /> No. <br /> Stories; <br /> <br /> Roof <br /> Type: mot~ - truss <br /> <br />~!ec bancboard - off, ce <br /> <br />Valuation: $ Lt-1 .~ 000. <br /> <br /> 1~0.00 <br />Permit Fee: <br /> <br />State Surcharge;; <br />Plans Chk. Fee: ,J+C-~ ~-.0 ~ <br />Septic Permit Fee;; <br /> <br />BTU; Total Fees;; 806,40 <br /> <br />ZONIN~q SEPTIC PLANS <br />~y:: , ~ ~y:: By:: <br /> <br />I agree to build according to the submitted plans and specifications, the iaw$ of the State of Oregon and the <br />County. Permit expires ff work not commenced withi~ 120 days I fu~hte~ expre~s/y warrant that I comply w)th the p~ovi~ions <br />701.~5 to 701. 12~ becgu$e: <br /> <br />( ) I~mar~i~ter~b¢i/dero~( J theauthor/zedrepresentatlveof~register~builder <br />( ) The work wdf be pe~ormed by a r~i~tered budder <br />( ) I am performing ~rk o~ a property I own or occupy <br />( ) Other (please ~edfy) <br /> <br />REMARKS i<xiGtinS s~z~c~uPe will be ~orn down this ~ill be built <br /> <br />in $~me spot. Size of septic tenk is unknc~,m. <br /> <br />I have read thi~ application in its entikety and certify that the stated information is true and correct to the best of my knowledge, <br /> <br /> '"~TURE OF APPLICANT:: )~ ~ . /~'./~C~--~'Z-~ · <br /> PLEASE NOTE: Driveway and sidewalk inspections are required by Pi 588-5036 <br /> <br /> Other; JuJred by this dept: Plumbing Electrical <br /> <br /> <br />