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MARION COUNTY BUILDING INSPECTION <br />COMMUNIT I' 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 />CRflS~ HTRFET : MTI.I. CREEK <br />PARCFI NItNBFR : 5~799-~ <br /> <br />OWNFR flAMF : SANTTAM flflMF~ <br /> <br />APP.TRANT <br /> NAMF : <br /> <br />GOMFR,R~I~K <br />CAPITOl. AWNTHQ <br />5IR VAIIFYWflO~ DR ~F <br />~AI.FN~ OB <br />7A?'7744 <br /> <br />CONTRACTOR/ :CARVFR FNTFRPRT~FR I.I.C <br />A~FNT ~ ~MFR~R]'CK <br />PHONE : 749-7744 <br /> <br />~N~TAItFR : <br /> PHONE : <br /> <br />97~fl4 <br /> <br />t AND ttSE-~ <br /> <br /> OCCB: 009894~ <br />MD LICENSE: <br /> <br />tINCT ~0 FT ~ <br /> <br /> liners O~c)'~pt~nn Fee <br /> ~ M~nufartHrPd dwe~]~ng fee 245.00 <br /> t ~at~ surcharg~ 12.25 <br /> ] ,S~ate administrative fee 2B.00 <br /> <br /> Assessed fees 277.25 <br /> Adjustments <br /> Total fees 277.25 <br /> PAYFF: ;flMFS~RICK Total p~yments: .00 <br /> Balance ~ue : 277.25 <br /> <br /> TH[S TS N6T A PERfl[T. TH[S APPLICATT~# I~T ~ THROUGH A SINULT~EOIJS RE¥IE~ <br /> PRfI~.F~t~ VMFRF ZON~NC. SEPTIC (~F RPPtICARtE) &Hi) SITE PLAN IS CHECKED PRIOR TO <br /> THE TR~IANC. E OF APE. RMITo IT IS THE RESPONSISILITY OF THE APPLICANT TO ASSURE <br /> THAT At ! NFCF~S~RY INFORMATION I5 PROVI~FP. Ag lOON AS ALL REGUIREHENTO OF THE <br /> REV[E# HAVE SEEN HE.T, YOU #ILL ~ HOTIF[;D THATYOUR PERHIT H~5 BEEN ISSUE~. <br /> R~NATHRF OF APPLICANT: <br /> <br /> D~NAID F W~ODI FY~ flAR~ON COUNTY BtI~ID~NG OFFICiAl / BY PMUNRO <br /> <br />................................... FOR OFFICE USE ONLY ......................... <br /> S~TF / IIGR= AM FD <br /> MAP= 51 7r)NE: T PROPERTY I.OCATOR~ 081W30 02308 <br /> <br /> RFDD RFTBACKR~Fronf: ~0~ left: 15 R~ght: ~5 Rear: ~5 Special: <br /> <br /> Pt,AN RFV[EW ~ DATE: 7fiNING REVIEW: DATE: <br /> <br /> <br />