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ACT'V'TY # ~ <br /> <br />PLEASE FILL OUT THE FOLLOWING INFORMATION AND YOU WILL BE DIRECTED TO THE NEXT <br /> <br /> APPLICATION SUBMITTAL <br /> <br />[] DWLLIN [] SUlLDINe O OLmON [] <br />[] DWELLING LABEL [] SiTE PLAN REVIEW ~' <br />[] MANUFACTURED DWELLING [] SITE EVALUATION ~ <br />[] MANUFACTURED STORAGE I-~ SITE EVALUATIONISEPTIC [] <br />[] PRE-FAB [] SEPTIC [] <br /> <br />z <br /> <br />ELECTRICAL J;~ <br /> <br />MINOR EL LABEL <br /> <br />P,UMSiN <br /> <br />DRIV~AY <br /> <br />~FORMATION <br /> <br />.//? <br /> <br />O0 I am performing the wor~ on property I own or occupy. <br /> <br />() <br /> <br />I am a registered builder or the authorized representative of a registered builder. <br />State of Oregon Construction Contractor's Board Registration # <br />FAX~ <br /> <br />(~ 1 am the authorized representative of the properly owner or contractor. <br /> <br />( ) I will be hiring a general contractor registered with the Construction Contractors Board. <br /> <br />This application may go through a simultaneous review process where zoning, septic (if applicable) and <br />construction requirements are checked prior to issuance of a permiL it is ~e responsibility of the applicant <br />to assure that all necessary information has been provided. <br /> <br />As soon as all requirements of the review have been met, you will be notified that your permit has been <br />issued and ready to be picked up. <br /> <br />1 certify that I have read this application and state that the Information given Is correct. I agree to <br />comply with all state laws and county ordinances relating to building construction. I will authorize <br />a representative of Building Inspection to enter on the property for the purpose of making <br />inspections for this permit. <br /> <br />SIGNATURE OF APPLICANT: ~ <br /> <br />FOR OFFICE USE ONLY: GEODISTRICT: R..OOD PLAIN SUDE.~ HISTOR]C.~ WETLANDS LAND USE CASE <br /> <br />MAPPAGE:,~ ZONE: CROSSSTREET: TA,~ACCT# <br /> <br />SUBDMSION: LOT# BLOCK# <br /> <br /> <br />