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• �ti w� Agricultural or Forestry Building Exemption Certification Equine Facility Exemption Certification Marion County Public Works—Building Inspection Dii o ^ ., Marton " 5155 Silverton Rd.NE, Salem Oregon 97305 ID, Ilv" County , Phone: (503) 588-5147 Fax: (503) 588-7948 Email:building(& o. arion.or.us J OREGON 6 2022 �{ Site Plan is Required—see attached information MARION COUNTY UfLpInIr I��j-� rT'n Owner/applicant name: Hazenberg Dairy Phone: 503-899-0094 Small Cbi7orjhzttPt'otrtTPcom Mailing address: 5828 Champoeg RD NE City/State: St. Paul, OR Zip: 97137 Job site address: 2ereg-RD NE L// /243 (dell City/State: St. Paul, OR Zip: 97137 Parcel Information: Parcel Size: \L1.(DG A-C, Parcel No.: 01-i f U;000 Iync) Zone: Proposed Building Information Describe specific use of the building and items contained within Cow barn for cows. Building Data: Length: Zug' Width: 1'-)(i' Area: 2I { Height: Type of Exemption: I Agricultural Building ❑Forestry Building ❑Equine Facility(Provide information below): What is the proposed maximum number of people(including employees, owners, etc.)that will be present in the building at any one time? 4 n Will this structure be used by the public at any time? ['YesU No Is the proposed structure located within a floodplain? oYes I No Q Is the building located on/used in the operation of a farm? UYes ❑No Is the proposed structure a residential dwelling or manufactured home? oYes I No Is the use of the structure or the items within it used for any business or commercial activities? oYes U No If yes,please explain: Agricultural/Equine Exemption Criteria—Select all that apply: ❑ Storage,maintenance, or repair of machinery, equipment, and supplies used on this farm ❑Raising,harvesting, or selling crops raised on this farm I Feeding,breeding,management, or sale of livestock,poultry, furbearing animals, or honeybees I Dairying or the sale of dairy products produced on this farm ❑ Other agricultural,horticultural, or animal husbandry used ❑ Stabling,training,riding lessons, or clinics (Complete Equine Exemption Criteria) #of stalls/horses #of stalls/horses for personal use only #of stalls/horses used for commercial or trade purposes including boarding,training,rentals,clinics, shows, etc. Which of the following systems will the proposed structure have? Electrical NYes ❑No(Complete Electrical Wiring Criteria) Will there be a concrete slab either within or adjacent to the building? PYes ❑No Will there be farm animals (poultry excluded)within the building at any time? !Yes ❑No Will there be farm animals (poultry excluded)on the slab at any time? oYes U No Will the building be used for storage of feed,hay, or straw? oYes U No Will the building be used for major repair of motor vehicle equipment? oYes U No Heating/cooling/ventilation/mechanical oYes U No Septic oYes 'No (Any yes answer will require a separate permit) Plumbing(Please specify fixture type) oYes U No Page 1 of 5