|
MARION COUNTY BUILDING INSPECTION
<br /> SENATOR BLDG. NO.
<br /> 220 HIGH STREET NE
<br /> SALEM, OREGON 97301
<br />
<br /> PHONE 588-5147
<br />CODE-A-PHONE 4:30 RM - 8:00 A.M.
<br />
<br />~ am a registered builder OR ) the authorizes representative
<br />
<br />I have read and agree to the terms stated on the reverse side 0f
<br />this document,
<br />
<br />SIGNATURE OF APPLIOANT[
<br />
<br /> DATE:
<br />
<br />°wN~'Tr ~: ,.'J/2J/o: -r.' ] 'vi2;,
<br />SiTUSAODRES~!~(3:OIJ. I, 'Pi/~'.Y!\ii~ t..
<br />
<br />9?325
<br /> :vblR i ON CC)UNTY NO
<br />
<br />LOT: St,GCK SECTION: TOWNSHIP: RANG~¢ALU,~,"' i {}¢"'i: ZONE~
<br />
<br />WIDTH: 'j DEPTH: AREA: ¢.~ UNITS; ~S IRREG, LOT; '2~J CORNER; /~'.k
<br /> 5.39000 .aC '¢~S NO
<br />
<br />CATEGORY:
<br />
<br />OCCUPANCY;
<br />
<br />OCCUPANT LOAD:
<br />
<br />MAP:
<br />
<br />NO. OF BEDROOMS:
<br />
<br />.... /""~ 'lYE 5X '" E'
<br />
<br /> EX i
<br />"':.""'.cSC""~:, ',"' ~X!STiN5 DRAIN FIELD ...7NEE
<br />,~C,OI, }',~-v",'i: '._ EE~T:C TAN;(
<br />
<br /> .'AN 7 T 'F
<br /> 5 ¢.1: :.'
<br />
<br /> ~ 55 .'CS
<br />
<br />THIS
<br />
<br />%~'""'!i 'i '~E(]E'£P'* i, ,~
<br />',u.: :.:, d ... .'.v ,_. ~ .............. ,,¥~E,.~, _,. r_.C, .~'
<br />
<br />· :.:... ,',", z.,,,~.:; L ',. z , ,., . ,,} ~e~m~s~.0p,,s~-~;;m,,,eE~ge~,S~S> ~,~.
<br />...... , -,...~ ,....,. ,, ~. ....... ~ ~, ,~. ........... ,~ ~,--~ ..... ~ ........ ~,~ .......... ~ .........................................................
<br />
<br />" :Hie I~ A VALID E~iT ; THIS ,~80 ITc I~E D,,IE. _~'
<br />~oI~JC, ION FA~S TO MEE AL~ RE~IR~IS OF, STAIB ~&~ ~D ~A<~ COUNT,
<br />ZONING ORDIN~ICES, THIS PE~It",~AL~,~NUBL':~D,,}¢QID; '~'
<br />
<br />FORM # MC $5-56 R[V. ,1/8~ OFFICE COPY
<br />
<br />
<br />
|