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MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> <br /> 285 Church Street NE · Room 132 ° Salem, Oregon 97301-3670 <br />Office Hours: 8:00-4:30 ° Phone: (503) 588-5147 * 24-HR Inepectlon Line: (503) 373-4427 <br /> <br /> ON-SITE RPPLICATION <br />BAI~JTIIIE z ~7/24/96 14;52 ~'~TI¥ITY NO = 96-~5556 ....~ <br />~y ' SI) ' BEM~L'TATU9 IE~ : M)PLIE'~ / <br /> : R-3 : f)7/24/19~ <br />P~T,E ' z I {{P N~I. IED z ~?/24/1~t96 <br /> TO EXPIRE z ~1/21997 <br />WORK BE'SC ~ SP: INSTALLATIOH <br /> <br />EXIST BEDROOMS: <br />FXIST ENPLOYFE: <br /> <br />SITE <br /> <br />PROPOSED BEOROONS : <br />PROPOSED EHPLOYEES: <br /> <br />11778 SIMPSON R~ SE AN <br /> <br />CITY: MARION COUNTY <br /> <br />SUBDIVISION : LOT: BLOCK: <br />CROSS STREFT : SHERMAN RD SE <br /> <br />PARCEL NUMBER : 5~13~-~BB <br /> PARCEL SIZE : ?B.~AC <br /> <br />ADDRESS <br />PHONE <br /> <br />APPLICANT <br /> HAllE <br /> ADDRESS <br /> <br />WTLLETTS. pAUL <br />11278 SIMPSON RB SE <br />AtlMSVILLE, OR ~[(~/97325 <br />541-74,-34'~ ~ <br /> <br />WILLETTS PAUL <br />11278 SIMPSON RD SE <br />AUMSVILLE OR <br /> <br />PHONE = 541-74B-3466 <br /> <br />OEQ CONTRACTOR: WILLETTS PAUL OEO LICENSE: <br /> / AGENT : WILLETTS PAUL OCCB: <br /> PHONE : 541-74S-3466 <br /> <br />Untts pescript~on Fee <br />I Construction Pernit ~2.B~ <br />1 DER Surcharge 3S.~0 <br /> <br /> Assessed fees : 382.00 <br /> Adjustments : .~0 <br /> Total fees : 382. B0 <br />PAYEE: WILL.ETTS PAUt Total payments: 382.00 <br /> Salance due = .00 <br /> <br />mis I,{ NOT A PERfllT. TNI8 APPLICATION <br /> <br />I~VE BEEN MET~ TOU gILL ~ NOTIFIED. <br />SIGNATURE OF APPLICANT: -~J <br /> <br />))ONAtD F. WOOI)LEY, MARION COUNTY BLIILDING OFFICIAl_ / BY CLYNCH <br /> <br />..... .o. omc USE T.X X..OT. .............. <br /> P~TY ~TDRs S81#20 01~00 <br /> <br />SEPTIC REVIEW] DATE: ZONING REVIEW: DATE: <br /> <br /> <br />