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- -. MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> <br /> 285 Church Street NE · Room 132 · Salem, Oregon 9'7301-3670 <br />Office Hours: 8:00-4:30 ° Phone: (503) 588-5147 · 24-HR Inspection Line: (503) 373-4427 <br /> <br />OH-SITE APPLICATIOH <br /> <br />DATE/TIHE = 01/27/97 <br />TYPE : SP <br />OCCUPAHCY : R-3 <br />PAgE : 1 <br /> <br />1B:22 <br /> <br />ACTIVITY NO : 96-88241 <br />STATUS = APPLIED <br />SE APPLIED = 01/23/1997 <br />SP APPLIED = 01/23/1977 <br />TO EXPIRE = 87/23/1997 <br /> <br /> WORK ~ESC : <br /> <br />EXIST BEOROOMS: <br />EXIST EMPLOYEE: <br /> <br /> SIT~ ADDRESS : <br /> <br />SP: INSTALL FOR F~ RTURF MANF~-,~-B]IRM HOME <br /> <br /> PROPOSED BEOROOMS : 3 <br /> PROPOSED EMPLQYEES: <br /> <br />10647 LEYERMAN RD SE AM <br /> <br />CITY: MARION COUNTY <br /> <br />SUBDIVISION : <br /> <br />CROSS STREET : MILL CREEK RD SE <br /> <br />PARCEL NIJMBER : 56466-250 <br /> PARCEL S~ZE : 2.5AC <br /> <br />LOT: BLOCK: <br /> <br />OWNER : ,ONKLIN, RALPH & ~ATRI,~A <br />ADDRESS : 1951 LABONA DR <br /> EUGENe, OREGON <br />PHONE : 541-688-6144 <br /> <br />AUTH AGENT <br />ADDRESS <br /> <br /> PHONE : <br /> <br />BFQ INSTAI. t. ER : STAYTON~ ML CTY & SI[VERTON SEPT <br /> <br /> PHONE : (503) 76~-2302 ~'-,x)2('~?~-~-, <br /> Units Description <br /> ~ DEQ Surcharge <br /> <br />DEQ LICENSE: 34716 <br /> <br /> Fee <br /> <br />30.00 <br /> <br /> Assessed fees : 382.08 <br /> Adjustments : <br /> Total fees : 382.80 <br />PAYEE: Total paynents: 382.80 <br /> Balance due ' .0~ <br /> CONKtlN PATRICIA ., <br /> <br />THIS IS NOT A PERHIT. THIS APPLICATION NUST GO THROUGH A REVIEW PROCESS WHERE <br />SOIL~ FEASADILITY AND INSTALLATION REOUIREHENTS ARE CHECKED PRIOR TO THE ISSUAHCE <br />OF A PERHIT. IT IS THE RESPO~IBILITY OF THE AP~ICANT TO ASSURE THAT ALL <br />NECESSARY INFORHATIOH IS ~OV]ED. AS S~H AS A~ REDUI~HEHTS OF ~E REVIEW <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> ....... <br />SEPTZC REVIEW: ~TE~ ZOHIHG REVZE~ DBTE. <br /> -% <br /> <br /> <br />