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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> I have read and agree to the terms stated on the reverse side of <br /> <br /> DATE: 10/07/c73 TIME: <br />OWNER; CONNIE NEELEY <br /> <br />: SITgS ADDRESS; <br /> <br />SIGNATURE OF APPLICANT: <br /> <br />DATE: <br /> <br />TAX lO": : ~:z~,~,o~J'ENT i AL <br /> <br /> ,~4 ASPEN DR <br />AUMSVILLE <br /> <br />MRN UI" RL;/UI'(ED <br /> STRUCTURE <br /> <br /> ~ONS~Rgc~iON "¢~P~: :OCCUPANCY: <br /> R-3 <br /> <br />OR 97325 . C~[,~},T[jG~..~E : g~j~j :Od~UPANT LOAD: <br /> <br />MAILING ADDRESS: SUBDIVISION; <br /> MILL CREEK ESTATES <br /> ACEN'T: CRAIG LUCAS-SANTIAM HOMES <br /> 76c?-7744 <br /> PHONE: VALUATION: <br /> <br />NO OF B£~OOMS' <br /> <br />LOT: ! BLOCK: : SECTION; TOWNSHIP; ' RANGE; ~ ZONg: ~ MAP: <br />!WIDTH; 55 DEPTH: 93 AREA: 5115. iUNIT~F , IRl~.~. LOT: <br /> <br /> TYPE: HANUFACTURED STRUCTURE PERHIT OR APPLICATION NO: <br /> CONTRACTOR, NO. 38238 <br /> Da~el L Carver <br /> 11~7~ Hill Creek Rd <br /> AuMsv~lle~ 97325-0000 <br /> PNONE: 769-7744 <br /> <br /> ITEM QUANTITY AMOUNT <br /> MANUFACTURED STRUCTURE PLACEMENT/CONNECTION $182.88 <br /> MANUFACTURED STRUCTURE STATE FEE $20.00 <br /> MANUFACTURED STRUCTURE STATE SURCHARGE $9.10 <br /> <br /> TOTAL ASSESSED FEES $211.10 <br /> PREVIOUS RECEIPTS $0.00 <br /> THIS RECEIPT $211.10 <br /> ~BALANCEh / DUE $0.00 <br /> PAYEE: Del McCormick :~L~ INVOICE 52898 <br /> RECEIVED BY: DM2 2~._~. TYPE: IN CHECK ~: 0 <br /> .................. ============================= ...... . ............................... <br /> * THIS IS NOT A PERMIT. THIS APPLICATIUH MUSTGO:THROUGH A RE¥IE# PROCESS WHERE THE <br /> FOLLOWING HUST BE OOHPLETED. ZTIS THE RESPOHSIBiLiTYOF THE APPLICAHT TO ASSURE <br /> 'THAT ALL HECESSARY IHFORMATIONHAS BEEHPROVIDE~. <br /> <br />PLANNING ACTION: <br /> PLAN REVIEW: BY ~ DATE' '~ "~-- <br /> ZONING: BY .......... DATE ........... <br /> <br /> CITY JURISDICTION: BY ........ DATE ......... <br /> REMARKS: MFG HOME <br /> <br />SETBACKS: FR 11 <br /> L$-15 <br /> R8-15 <br /> RR-10 <br /> sP"Z <br /> <br />FO.U # MC ~-S~ REV. ~/~)O OFFICE COPY <br /> <br /> <br />