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MARION COUNTY <br />DEPT. OF BUILDING INSPECTION <br />Senator Building # 225 ~__~ (~ <br />220 High St,,, N,E 2nd Floor Permit No,, <br /> Salem, Oregon 97301 <br />R.H. WITHROW, BLDG. ADMINISTRATOR <br /> <br />Plans by:: Phone: Address: <br /> <br />MapPage Zo~' 1 ZoneChg, 1 Part. Cond Use <br /> <br />Rge,, <br /> <br />Variance J Fire Zone Occupancy Type of Const <br /> <br /> Min Req Front Sides Rear <br /> Setbacks;; <br /> <br />Lot No: Bik,, No: ~ <br /> <br />Water Supply: <br /> <br />Sewage ~ <br /> <br />Area of Bid§: ~'Z~"IV,~ <br />Basement: ~ <br />Heating <br />System:: __ <br /> <br /> Sub dy. Lot Size __ , , Corner? <br /> <br /> :3 JOt) -- <br /> Site <br /> Evah Permit Fee:. <br /> No- / <br /> Stories: State Surcharge:: <br /> <br />, Type: Plans Chk,, Fee: <br /> Septic Permit Fee:: <br /> <br />BTU; Total Fees: <br /> <br />Rcpt, No;; <br /> <br />VALIDATIONS. <br />ZONING SEPTIC TANK PLANS <br />By:: By. IBy ...... ~~*~ ~ ~ .~! .~_~ <br />Date:: Date Date <br /> <br />I agree to build according to the submitted p/an~ and specifications, the laws of the State of Oregon and tbe Oridnance~ of <br />County, Permit expiYe~ if work not commanced within 120 days I furhter expressly warrant that I comply with the provis~ons of ORS <br />701,,0~ to 70~. ~25 <br /> <br />(~) I am a registered builder or ( ) the authorized representative of a registered builder <br />(/) The work wUI be performed by a registered builder <br />( ) I am performF?g work on a property I own or occupy <br />( ) Other (please specify) <br /> <br />REMARKS:; <br /> <br />SIGNATURE OF APPLICANT ' ~- ~ _ -- .-- <br /> PLEASE NOTE:: Driveway and sidewalk inspections are required by Public Works:: 588-5036 <br /> Other permits required by this dept: Plumbing [] Electrical ~ <br /> <br /> <br />