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qs.1317L <br /> <br /> IvIARION COUNTY <br /> BUILDING INSPECTION <br /> Senator Building ,* 220 High Street NE · Second Floor a Salem. O~:gon 97~01-3670 <br /> <br />Is this property classified as farm deferred? Y ~/ N <br />Building, 495 State Street, Salem) <br /> <br />Describe in detail your commercial farm enterprise: ~,~ n~ ~ <br /> <br />Describe in detail the use of and/or oo~modities stored in the proposed structure: <br /> <br />Is the proposed structure located within a flood plain? Y __ N. ~ .... <br /> <br />Does the proposed str~ucture have any of the following systems? <br />~leetrical ¥ N / Plumbing Y N v/ Heating/Cooling/Ventilation Y__ <br /> <br />where will restroom facilities be provided9 ~ <br /> <br />Will persons be working in the structure more than a total of 144 hours, <br />week of the year? Y N ~/ <br /> <br />Is this structure used by the public at any time? Y N V/ <br />Explain: <br /> <br />during any <br /> <br />10. <br /> <br />11. <br /> <br />What is the distance fro~ the'proposed structure to property lines and/or other <br />structures? Front ~ ~ Rear /~0 /~. <br /> Left Side ~O' Right Side' ~Z; O~her structures <br /> <br />This application will not be considered complete without a site plan. See attached <br />site plan requirements. <br /> <br />! certify that I have read this application and state that the information given is <br />correct. I agree to comply with all State laws and county ordinances relating to building <br /> <br />SIGNATURE <br /> <br />DATE <br /> <br />PHONE <br /> <br />NAME (Please print) <br />STR~ET~AgDRESS <br /> <br />CITY STATE ZIP <br /> <br />O,F C USE 'SI S .o. <br />PLANNING DIVISION: ', <br /> Validated <br /> <br /> BUILDING DIVISION = <br /> Validated By: ~ Approved; V/ Denied: Datel ~/~ <br /> <br /> ~PROVED: ~ DENIED: STRUC~ PE~IT IS ~QUIRED <br /> Othe~ pe~it~ required: ~lectrical~ PlYing, Mechanical, Septic <br />MC 15-76 <br />REV 9/93 <br /> <br /> <br />