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MARION COUNTY BUILDING INSPECTION <br />SENATORBLDG NO.. 225 <br />220 HIGH STREET NE <br /> SALEM, OI~EGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4::80 PM - 8::00 A.M <br /> <br />Other_ <br /> <br /> i have read and agree to the terms stated on the reverse side of <br /> <br />OATE¢ 04/28/88 TIME; 10;10:43a <br /> JOHNSON, EARL <br /> <br />SITUS <br /> <br />SIGNATURE OF APPLICANT <br /> <br />CONSTRUCTION TYPE <br /> <br />OCCUPANCY <br /> <br />RESI DEN'T'IAL <br /> <br /> 8754 MILL CREEK RD <br />AUMSVILLE, OREGON <br /> <br />OR 97325 <br /> <br />SE <br /> <br />CONTRACT CITY ¢ UGB <br />MARION COUNTY i NO <br /> <br />SUBDIVISION <br /> <br />OCCUPANt LOAD <br /> <br /> 3 <br /> <br /> PHONE i 74,9-2601 <br /> <br />LOT BLOCK <br /> <br />SECTION TOWNSHIP <br /> 28 <br />A~!EA 85.8800 UNITS <br /> <br /> SITE NUMBER.- 42'75 <br /> VALUAT l ON: <br /> <br /> RANGE ZONE <br />8S 2~ EFU <br /> <br />AC IF~F1EG LOT NO CORI~ <br /> <br />TYPE: MOBILE HOME <br /> <br />CONTRACTOR, NO- <br />JOHNSON, EARL <br />SAME <br /> <br />PEP~IT OR APPLICATION NO: <br /> <br />9008145 <br /> <br />PHONE: 749-2601 <br /> <br /> ITEM <br />MOBILE HONE FIRST WIDTH <br />MOBILE HOME ADDTL_ ~IDTR <br />MCSILE HOME ZONING SURCHARGE <br />FLEET SURCHARGE -ZONE 3 <br />MOBILE HOME STATE SURCHARGE <br /> <br />QUANTITY AMOuN~ <br />1 <br />1 $15.00 <br /> $2.50 <br /> $3.84 <br /> $2.5O <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$58_84 <br /> $0.08 <br />$58.84, <br /> <br />BALANCE DUE <br /> <br />PAYEE; JOHNSON, EARL ~ RECEIPT NO: 8795 <br />RECEIVE0 BY: CL ~"'~/"-:: - - ~ TYPE: CK CHECK ~: 713 <br />.......................... <br /> ~ THIS IS NOT A PERMIT. THIS APPLICATION D~JST GO THROUGH A REVIEN PROCESS WHERE THE <br /> FOLLONING f4dST 8E COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> ALL NECESSARY INFOF~IATION HAS BEEN PROVIDED. <br /> <br /> PLAN REVI EN- <br /> <br /> PLANNING ACTION; <br /> <br />CITY JURISDICTION: BY ......... DATE ......... <br /> <br /> <br />