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MARION COUNT7 BUILDING INSPECTION <br />COMMUNll f DEVELOPMENT CENTER <br /> <br /> 285 Chur©h Street NE * Room 132 · Salem, OregOn 97301-3670 <br />Office Hours: 8:00-4:30 · Phone: (503) 588-3147 * 24-HR Inspection Line: (503) 373-4427 <br /> <br /> ON-SITE APPLICATION <br />DATE/T[HE = 06/17/96 16=~5 ACTIVITY HO : 96-6438? <br />TYPE : SP STATUS : APPLIED <br />OCCUPAHCY ; R-3 SE APPLIED <br /> PAGE : ! SP APPLIED = 66/17/1996 <br /> TO EXPIRE : 12/11996 <br /> <br />W~RK DES[; : AtI'FH/MINOR/HARDSHtP <br /> <br />EXIST BEDROOMS: 2 PROPOSED BEDROOMS : 5 <br />EXIST EMPLOYEE: PROPOSED EMPLOYEES: <br /> <br /> SITE ADDRESS : CZi'Y: MARION COUNTY <br /> ~625 MIX RD SE AM <br /> <br />: LOT:: BLOCK: <br /> <br />· ~uo. STREET : <br /> <br />PARCEL NUMBER <br />PARCEL S.17E <br />OWNER <br /> NAME <br /> Al)DRESS :: <br /> <br />PI]RTER Rh 91-!i <br /> <br />60491-880 <br /> 2. SAC <br /> <br />M~X.WESL, EY & ELSIE L <br />106~5 fl[X RD <br />AL MSV [LLE, :flR <br /> <br />FH( IqE : 399-8401 <br /> <br />APPLICANT <br /> NAME <br /> ADDRESS <br /> <br /> PHONE : <br /> <br />DEQ CON'FRACTOR~ M[X~,IEROLD <br /> / A~FN'F M]X~,JEROLD <br /> PHONE ~.~81-0~72 <br /> Units <br /> 1 <br /> <br />97302 <br /> <br />MIX, JEROLD <br /> 4770 JONES RD SE <br />SALEM <br />OR <br />58~ -0922 <br /> <br />973~2 <br /> <br />Description <br /> <br /> Au. thori~at~on w/Field Visit <br /> gED Surcharge <br /> <br />DEQ LICENSE: <br /> OCCB: <br /> <br />217.00 <br />30.00 <br /> <br /> Assessed fees : 247.00 <br /> AdjustMents : <br /> Total fees : 247.00 <br />PAYEE: M[X~JFROL. D Total pax~ents: 247.00 <br /> Balance due : .00 <br />********************************************************************************** <br /> <br />THIS IS NOT A PERHIT. THIS APPLICATIOH MUST GO THROUGH A REVIEW PROCESS WHERE <br />SOIL, FEASABILITY AND ;INSTALLATION REOUIRENEHTS ARE CHECKED PRIOR TO THE ISSUANCE <br />OF A PERHIT. IT IS THE RESPOHSIBILITY OF THE APPLICANT TO ASSURE THAT ALL <br />NECESSARY IHFORNATIONiIS PROVIDED. AS SOON AS ALL REOUIRENENTS OF THE REVIEW <br />~AVE BEEN NET~ YOU WIlL BE N~)TIFIED. _ <br /> <br />~ONALO E,. B~ODi, EY~ H~R~O.'N~)UNTY BtY[LI)[NG OFFICIAL / BY MBUL.L <br /> <br /> OFFICE USE ONLY. THIS IS NOT A PERHIT .................. <br />MAP: 6~ ZONE: EFU PROPERTY LOCATOR: 091W05 <br /> <br /> ~~~TIC REVIEW: DATE: ZONIH~ REVIEW: DATE: <br /> <br /> / <br />/ <br /> <br /> <br />