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MARION COUNTY <br /> DEPT, OF BUILDING INSPECTION <br /> '~ Senator Building ~ 225 <br />Appl, J~evd "'/' , / .- 220 High St., N.E, 2nd Floor <br /> ~/5 ' ,,;,// Salem, Oregon 97301 <br />By: '~' ~7~,'~ ,~/,/~'~/~/~"P~"~"~'~U R.H. WITHROW, BLDG-ADMINISTRATOR <br />,~ / ~ ' '~ ~:~ ' ~ 588-B147 - 588-5148 <br /> <br /> __Tax Lot No; <br /> <br />q9 4/ See. <br /> <br />Twnshp. Rge <br /> <br />Mae Page [ ZOne 7one Chg. I Part. Cond. Use Variance " Fire Zone <br /> <br />Water Supply: ~Y-,'~'~-'t :~ ¢q .... <br />Sewage ¢ - ?., Site <br />Area of Bids; ~ No. <br /> <br />Heating <br />System; ~_.~ <br /> <br />Stories: <br /> <br />Type: <br /> <br />BTU!_ /1~ O ,,J~ <br /> <br />Valuation; <br />Permit Fee; <br />State Surcharge! <br /> <br />Septic Permit Fee: <br /> <br />Rcpt. No: <br /> <br />I agree to build accord/ns to the ~ubmitted plans and speclflcatlona, the laws of the State of Oregon and the O/~on <br />SIGNATURE OF APPLICANT:~_..~:~¢~ ). /~ .. <br /> <br />VALIDATIONS: <br />ZONING <br />By: <br /> <br />SEPTIC TANK <br /> <br />REMARKS <br /> <br />By: <br />Date: <br /> <br />PLEASE NOTE: Driveway and sidewalk inspections are required by Public Works; 588-5036 <br />Other permits required by this dept: Plumbing [] Electrical LJ <br /> <br /> <br />