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MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> <br /> 285 Church Street NE * Room 132 · Salem, Oregon 97301-3670 <br />Office Hours: 8:00-4:30 · Phone: (503) 588-5147 · 24-HR Inspection Line: (503) 373-4427 <br /> <br />ON-SITE APPLICATION <br /> <br />DATE/TINE : B6/BS/96 <br />TYPE : SP <br />OCCUPAHCY : R-3 <br />PA~E : ! <br /> <br />14:~1 <br /> <br />ACTIVITY NO = 76-S3988 <br />STATUS : APPLIED <br />SE APPLIED : <br />SP APPLIED : ~6/85/1996 <br />TO EXPIRE : 12/81996 <br /> <br />WORK DES(: : MA,IOR REPAIR <br /> <br />EXIST BEDROOMS: 99 <br />EX]ST EMPLOYEE: 9~9 <br /> <br />PROPOSED BEDRUOMS : 99 <br />PROPOSED EMFLOYEES. 999 <br /> <br />SITE ADDRESS <br /> <br />CITY: MARION COUNYY <br /> <br />5:~48 DUMORE DR SE. AM <br /> <br />SUBDIVTS [llN : LO[: BLOCK: <br /> <br />CROSS STREET : S1LVERF~W_LS HY <br /> <br />PARCEL. NUMBER : 75,~20-260 <br /> PAR£EL S. 7E : 2.5AC <br /> <br />OWNER <br /> NAME <br /> ADDRESS <br /> <br />FHONE <br /> <br />HOLM, THOHAS E & BE'rlY R <br />5348 DOM(TRE DR NE <br /> [, <br />AIhSV1LLE~ OR <br /> 97~25 <br />D~4-2~0 <br /> <br />APPLICANT <br /> NAME <br /> ADDRESS <br /> <br />PHONE <br /> <br />: HOLM, THOMAS E & BEI*I'Y R <br />: <br /> 5348 DUHORE, DR NE <br /> AOMSVILLE, OR <br /> 97~25 <br />: 364-2~3~ <br /> <br />DEQ CONTRACTOR: VALLEY SEPTIC SERVICE OEO LICENSE: 136786 <br /> / AGENT HOLM,THOmAS E & BETTY R OCCB: <br /> PHONE :: (583) 588-11'15 <br /> <br />Units Des,( F ~d:tt ion Fee <br />1 DEQ Sm"tTharge 30.00 <br /> <br /> Assessed fees : 21.0.00 <br /> Adjustments : .00 <br /> Total fees : 210.00 <br /> PAYEE: HOLM, THOMAS E & BE'ITY R Total ?y~ents: 2t0.00 <br /> Bat~nc~ due : .00 <br /> <br /> ~HIS IS NOT A PERHIT. THIS APPLICATION MUST GO TttROIJGH A REVIEW PROCESS WHERE <br /> OIL. FEA~DILITY AND INSTALLATION REQUIREMENTS ARE CHECKED PRIOR TO THE ISSUANCE <br /> OF A PERMIT. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ~SS~E T~T ~L <br /> <br /> SIGW~'I'URE {1F APPLICANT: ~~~ ~ ~ ~ <br /> <br /> DORAl D E. WOODLEY~ MARION COUNTY BU]L. DINI, OFFICIAL / BY MBUI. L <br /> <br />.............. FOR OFFI~E U~E ONLY. THI~ I5 HOT A PERMIT .................. <br /> ~P: ZONE: AR PR~ERTY LD~TOR: 88~13B G18~G <br /> <br /> ~PTIC REVIEW: DATE~ ZOHIW~ REVIEW: DATE: <br /> <br /> <br />