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MARION COUNTY <br /> BUILDING INSPECIION <br /> Senator' Building · 220 High Street NE * Second Floor · Salem. Oregon 97301-3670 <br /> Office Hours: 8:00- 4:30 Phone: 588-5147 24 Hour Code-A-Phone: 558-791M <br /> <br /> APPLICATION FOR EXEMPT STATUS F [ ~ E <br /> (FROM ~E STRUC~ S~ECI~TY CODE) <br /> FOR ~ AGRIC~ BUILDING <br /> <br />~O~OS~D no~om /I & 7/ ~Zl:l,'~. ~P~ '~x acco~= I - ~/~-~ -/~ O <br /> <br />Is this property classified as farm deferral by the Marion County <br />Assessor Department? (You must provide a copy of your tax statement <br />shewing the farm deferral. ) Y,,,,~,,, N __ <br /> <br />Are you located within the Urban Growth Boundary? Y N ~ <br /> <br />Describe in detail the use of and/or co~odities stored in the proposed <br /> <br />4. Is the proposed structure located within a flood plain? <br /> <br /> 5. Does the proposed structure have any of the following systems? <br />. Electrical ~4/~ Plumbing ~/~ Heating/Cooling/Ventilation /~0 <br /> <br /> Where will restroom facilities be provided? ...... /~/0 <br />R[CHV[U'Will persons be working in the structure more than a total of 144 hours, <br /> <br />{¸% <br /> <br /> 'during any week of the year? Y -- N ~ <br />84 1~9~s this structure used by the Dublic at any time? Y <br /> Explain= <br /> COUNF! <br /> <br />site plan. <br /> <br />'~Y-'v'TT~S application will not be considered complete without a <br /> See attached site plan requirements. <br /> <br />10. What is the distance from the proposed structure to property lines <br /> and/or other structures? Front ~/=/-- Left Side , 2~/~/-- <br /> Right Side /~/- Rear ,,~ Other structures 3~ ~/- /~ /~ ~ <br /> <br />given is correct. I agree to comply with all state laws and ~ounty o~dinances <br />relating to building construction. <br /> <br />DATE ' ' ' ~ <br /> ~..zF-,Y 7~ / <br />PHONE <br /> <br />OFFICE USE ONLy SITUS NO. <br /> <br />Planning Division Validation By; .... ~. <br /> <br />NAME (Please print) <br /> <br />STREET ADDRESS <br /> <br />CITY STATE ZIP <br />ZOO: <br /> <br />COMMENTS: <br /> <br />7191 <br /> <br />Building Division Validation By: ~ <br /> <br />APPROVED: D~N~EO: ~/ PERMIT IS <br /> <br /> Other permits required= Electrical, Plumbing, Mechanical, Septic <br /> <br /> <br />