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Appl. Recd: By: Date: MARION COUNTY DEPT, OF BUILDING INSPECTION Senator Building ~ 225 220 High St., N.E. 2nd Floor Dot t-f e Salem, Oregon 97301 588-5147 - ~;88-$148 5/23/84, 5:00 P.M.- ........... COOE-A.Phone B88-5373 ........... 8:00 Type of Permit: Mobile home replacement, septic check & glec.~a~vot~eo:& connection Address: 1181/* F. hlen Roads 1~, I~.. Aurora Sec. 1~ Twnshp, ~ Rge. ~W Owner: Ketheri_,_.~.~_~ Hartill~ Hothe~Phone; 678-5357 Address.~l Phone: Address:_ H & K kamas of Oreson Portland Plans by: Phone: Address: Type of Conlt. No edrma. Mia Req. Fron Sld s Rear Lot No.: ........ BIk. No.: Sub dy, Lot Size 66.5 Comer?~_,Y,~$ Area of Bldg. 2nd Bose- Total Main Fir.: ......... Fir.: ....... ment: Area:~ Valuation: Bldg. Permit 50,00 Roof Type: Truss/Stick: ...... Fee: ( + 5%) ? _ ~Cl Heating Wood Water System: Stove- Supply: Elect, Fee:_ 6'0*00 Septic Tank New Site Evah__ Instal - Mech, Fee: ............ Exist. No. System:_ 78-1671 Gals . Plumb. Fee: State Surcharge~ 3.60 Plans Chk. Fee: Zonln~ .~lJJ.41 ~ ')'2,~.~~'Mechanical: Dote-~ /l~q-_?~ ..... ~-~- ~1 _Date= Septic Tank- ~ Plans. I agree to build according to the submitted plans and specifications, the laws of the Sta~ of Oregon and the Ordinances of Marion County. Permit expires Jf work not commenced within ~80 days. I further expressly warrant that I comply with the provisions of 701.005 to 701.1~5 because: ) I am performing work on a property I own or occupy ( ) I am a registered builder OR ( ) the authorized representative of a registered builder Septic Tank Permit Fee: 60,00 DEQ Surcharge:,, 1~,~ O0 TOTAL FEE: 161 ~0 RECEIPT NO.= The work will be performed by a registered builder Other (please specify) SIGNATURE OF - C N] _z.~'~~ .~ ~J~',~cL,~'l,l PLEASE NOTE: Orive~ay and sidewalk inspections are required by Public Works: S88-5036 Other permits required bv this dept; Plumbin~ [~] Electrical []