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Marion County EXPIRE® <br /> OREGON <br /> PUBLIC WORKS <br /> 0.03).,58875036 <br /> IVIARION COUNTY BUILDING INSPECTION <br /> BOARD OF DECLARATION OF PRIMARY ROW.0 31 3 SHIP <br /> COMMISSIONERS <br /> Calm Willis <br /> Sam Brentano The dwelling permit and/or septic permit being applied for&this address <br /> Kevin Cameron <br /> \....k_.;pcto is:for a dwelling that is my <br /> DIRECT°R ties E primary residence 1hr the majority' of each calendar year <br /> Brier Nigh ,R . - <br /> ADNUNISMAtION <br /> Square footage:ofexistineprevious dwelling: 15r-) <br /> eptumr46 <br /> #of existing Bedrooms 3 #of existing Bathrooms: <br /> .iNsPEaloN <br /> EMERGENCY <br /> MANAGEMENT Square footage of existingtprevious attached garage: <br /> ENGINEERING tam providing as proof ofprimary residency a copy of one Odle fonoviiv <br /> documents: <br /> ENWRONMENTAL <br /> SERVICES. X Driver's lice <br /> o Property tax r 0; • <br /> OPERATIONS o Utility bill <br /> o Bank or credit card statement <br /> PARKS <br /> O Pay stub <br /> PLANNINGPIANNIN o Voter registration card <br /> 1=1 Other <br /> SURVEY <br /> I hereby declare that the above statements and evidence provided is true to the <br /> best of my knowledge and belief,and that I understand it is subject to penalty for <br /> perjury, . <br /> Name- 'CAM P <br /> sign <br /> Date: "{kik/ <br /> Phone#: -563 g6Z-- -7 3 <br /> 5155 5-AN/Egon Road NE•Salem,OR 97.305.-3802• www.c.a.mariorkerms/PW <br /> PrintglicwrecYelecFpaper• Reduce—Reese—Recycle-Recover <br />