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MARION COUNTY BUILDING INSPECTION <br /> <br /> 3150 Lancaster Dr, N.E. · Suite C · Salem, Oregon 97305-1398 <br />Office Hours: 8:00-4:30 · Phone: (503) 588-5147 * 24-HR Inspection Line: (503) 373-4427 <br /> <br /> Oil-SITE APPLICATION <br /> ,I~TF. rTzsE : ~6/~i2/97 11:56 ~ZVITT ~ ~ 97~4~25 <br /> <br /> ~Y : R-3 ~ ~ZE~ : ~2/1~7 <br />..... P~ ~ ~ A~ZED : 96/92/1~ <br /> <br /> WORK DESC : SS: AOTH/FLD REPL= HF~ 2~X69 W/2BX56 <br /> EXIST ~EDROOHS= 2 PROPOSED BEDROOMS : 3 <br /> EXIST EHPLOYEE= PROPOSED EMPLOYEES= <br /> s~TE ADDRESS = CITY: MARION COUNTY <br /> B832 HOLMQUIST RD SE AH <br /> <br />SUBDIVISION : <br /> <br />CROSS STREET : BATES RD SE <br />PARCEL HUMBER : 56337-0~0 <br /> PARCEL SIZE : 1.B~ AC <br /> <br />OWNER <br /> ADDRESS <br /> <br />PHONE <br /> <br />LOT: BLOCK: <br /> <br />LUALLIN. WILLARD & ROSE,MARIE~//~ <br />8832 HOLMQUIST RD SE <br />AUHSVILLE OR 97325 <br />5~3-749-1~19 <br /> <br /> AUTH AGENT <br /> ADDRESS <br /> AUMSVILLE OR <br /> pHONE : 5~3-747-1B19 <br />DEQ *iNsTALLER : <br /> PHONE : <br /> <br /> Un,ts Oescr'[ption, <br /> ] Authorization w/F/eld Visit <br /> 1 DEQ Surcharge <br /> <br />: LUALLIN.WILLARD & ROSE,MARIE <br />: <br /> 8B32 HOLMQUIST RD SE <br /> <br /> ?7325 <br /> <br />DEQ LICENSE: <br /> <br /> Fee <br /> <br />217.BB <br /> 30.0~ <br /> <br /> Assessed fees : 247.00 <br /> Adjusteents : .00 <br /> Total fees : 247.00 <br /> PAYEE: LUALLIH~WILLARD & RosE, MARIE Total pa%merits: 247.~ <br />i Balance due : .0~ <br /> <br /> THIS tJ~PI. IC~TION I~T GO THROUGH A REVIEW PROCESS la4ERE <br /> THIS <br /> IS <br /> NOT <br /> A <br /> PERMIT. <br /> ~iOIL~ FE~ILITY /~ND INSTALLATION REGUIREMEHTs aRE C/4ECKEDPRIOR TO THE ISSUANCE <br /> 0¢ AP ER lilT. IT IS TIE RESPOI~IBILII~ OF ll~ API~.ZC~IT TO ASSU~E THAT ALL <br /> #E~6~R¥!NFORI~TION ISPROVlI)ED. AS SOON A5 ALL RF. GUIREHENTS OF THE REVIEW <br /> SiGNA'TUR~ O'F APPLICANT: [d_.~~, ~~ <br /> DONALD E. ~OODLEY, MARION COUNTY BUILDING OFFICIAL / BY CLYNCH <br />............ -FOR OFFICE USE OHLY. THIS IS HOT A PER~IT ............. <br /> 1~4P4~,48~ ......... ZO~:.~R PROPERTY LOC~TO~: SSI#31C <br /> <br /> <br />