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MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> <br /> 285 Church Street NE * Room 132 ·Selem, Oregon 97301-3670 <br />Office Hours: 8:00-4:30 · Phone: (503) 588.5147 · 24-HR Inspection Line: (503) 373-4427 <br /> <br />ON-SITE APPLICATION <br /> <br />~ATE/TINE <br />TYPE <br />OCCUPANCY <br />PN;E <br /> <br />: 1~/22/96 15:59 ~CTIVITY NO : 96-D842~ <br />: SP 5TALUS : APPLIED <br />: R-3 SE APPLIE~ : <br />: 1 SP APPLIED : <br /> TO EXPIRE : ~4/2~/1997 <br /> <br />NORK DESC : <br /> <br />EXIST BEOROOMS: <br />FXIST EMPLOYEE: <br /> <br />SITE ADDRESS : <br /> <br />SS:AUTH MFG HARDSHIP <br /> <br /> PROPOSED BEDROOMS : <br /> PROPOSED EMPLOYEES: <br /> <br /> 10313 MIlL CREEK RD SE AM <br /> <br />4 <br /> <br />CITY: MARION COUNTY <br /> <br />SOBDIVIS[ON <br /> <br />CROSS STRFET <br /> <br />PARCEL NOMBER <br />PARCEL. SIZE <br /> <br />56388-~80 <br /> ].OAC <br /> <br />LOT: <br /> <br />BLOCK: <br /> <br />OWNER <br /> ADDRFSS <br /> <br /> PHONE <br /> <br />SHIBLEY,NICHOLAS <br />18313 MILL CREEK RD <br />AIIMSV[LLE~ OR <br /> <br />747-1377 <br /> <br />Atil H AGENT : <br /> ADDRESS <br /> : <br /> <br /> PHONF : <br /> <br />DEO INS[ALLER : <br /> <br /> PHONE : <br /> <br /> Units <br /> <br /> 1 <br /> <br />SH I BLEY, N I CHOL AS <br />18313 MILL CREEK RD SE <br />AHMSVIL. LE, OR <br /> 973~5 <br /> <br /> DEQ LICENSE: <br /> <br />Descriotio~ <br /> 'A~-A-~ion w/Field Visit <br /> DEQ Surcharpe <br /> <br />Fee <br /> <br /> Assessed fees : 247.88 <br /> Adjustments : .88 <br /> Tot:el fees : 247.88 <br /> PAYEE: SHIBLEY~NICHOI.AS Total paxMents: 247.88 <br /> Balance ~ue : .88 <br /> <br /> THIS IS NOT A PER~IT. THIS NaPLIC~TION HUST gO THROUGH A REVIEM PROCESS MHERE <br /> SOIL~ FEASABILITY N~D INSTALLATION REGUISEHENTS N~E CHECKED PRII~ TO THE ISSUANCE <br /> OF a PERNIT. IT IS THE RESPONSIBILITY OF THE APPLICANT TO N~IJRE THAT RLL <br /> HECESSARY INFOR#ATZON IS PRDVIDE~. AS SOON AS ~ REGUIRE~NTS OF THE REVIEM <br /> HAVE DEN NET~ YOU MILL BE NOTIFIED. ~ / ~ <br /> <br /> I)ONA!.~ E. WOODL.~Y, HAR~ON COUNTY BIJILO[NG OFFICIAL / BY JSKYBERG <br /> <br />................ F~R OFFICE ~SE ONLY. TNIS IS NOT A PER~IT .................. <br /> ~AP: ZONE: AE PROPERTY LO~TOR: 881M31AAS1888 <br /> <br /> SEPTIC EEVIEM: ~A?E: ZONIN~ REVIEW: DATE: <br /> <br /> <br />