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MARION COUNl~ BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> <br /> 285 Church St.~e~ NE - Room 13~ ~ Salem, Oregon 97301-3670 <br />Office Ho.rs: 8:00~4:3i) * Phone;i(503) 588-$147 · 24-HR hlspectlen Line: (503) 588-?~:14 <br /> <br /> ON-SiTE APpL~CAT[~N ACTIVITY MO <br /> <br />~YPE : S~ ; APPLI/9 <br />~CCUPANCY : R-~ ,~ TO EXP~R/ <br /> <br /> "' "T F'ROF'(I~'~ EMPLOYEES: <br /> ~,~ E'F' ,.;YEL: ' <br /> C'I TY: <br /> ,.)~ r,. S <br /> ,.~?'E t ,' ' <br /> 225 PATTON Rg gT <br /> <br /> SIJI~D:[V'~ S ~ f}~} ~ LOT; BI_,gCK: <br /> <br /> F'ARCEt. Slt'.ZE : .~ AC <br /> <br /> : SHAFF'ER,,HICKEY D & SANDRA D <br /> NAHE:¢'''o~ l~;[B ~RD AV~ <br /> ~TAYTON, OR ~7:~8~ <br /> <br /> F .. [ ,~N ~ <br /> NAME :. SHAFFER~HiOKE, Y D & ~ANDRA D <br /> STAYTON,~ OA <br /> 97:t8~ · <br /> <br /> DEr,1 .r ] ~AC OR. KPJV.[N~S BACKDOOR SERVICE ~EQ L..[C~.NSE.; ~4421 <br /> / AGEZN'I' 81~AFFE~,,MICKCY D E SAND~A D <br /> <br /> rkal fees . <br /> ;~al paxments. · <br /> <br /> THIS IS NOT A PERMIT. THIS APPLICaTiON ~T g~ ~ROUGH A REVIEW PROCESS WHERE <br /> SOlL~ FEASA~ILZTY ~ND INSTALLATION ~IRE~ENTS ARE CHECK~ PRIOR T~ THE I~fiUANCE <br /> OF A PERMIT. ~T IS ~E RESPUHSIBILI~ OF;THE AP~ICANT TO ASSURE .THAT ALL <br /> WECESSA~Y INFOrmATION l~ PRSV~E~. A~ SO~H AS ~LL REQU[~E~ENT~ OF THE REVIEW <br /> <br /> O,f..-I.,, [-'. WOPDL,EY~ H~RZON COUNTY BUILDINg; ,OFF.,C~AL / BY <br /> <br /> ................. FO~ OFFICE USE ONLY. THIS ~8 NOT A PERHiT <br /> ~AP~ les ZONE: RS PROPERTY LOCATOR: <br /> <br /> - ~"* REVIEW. DATE: <br /> SFF']'[S ~EVI,~.w. DATE: ZQNiN~" ' · <br /> <br /> <br />