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BUILDING INSPECTION <br /> 3150 LANCASTER DR NE- SUITE C <br />-- SALEM OREGON 97305 503-588-5147 q ~... <br /> <br />PROPOSEO EOCA.ON: <br /> <br />BUILDING SITE ACRES: <br /> <br />1. Is this property classified by the Assessor as farm deferred? <br /> <br />2. Are you located within the Urban Growth Boundary? <br /> <br /> TAX ACCOUNT: '-'~ Z. I CC) <br />TOTAL# OF ACRES FARMED: <br /> <br /> yv/'N <br /> <br />Y Nk/' <br /> <br />3. BE SPECIFIC in describing your commercial farm enterprise, s~ze of operation, and annual profit. If applicable, <br /> provide proof of farm income for the last three (3) years. <br /> <br />4. BE SPECIFIC in describing the use of and/or commodities that will be stored in the proposed structure: <br /> \ .,_..- <br /> <br /> , <br />5. What is the size of the proposed buitding? LENGTH~ WIDTH ~/HEIGHT JOI AREA <br /> <br />6. [s the proposed structure located wdhin a flood plain? Y N ~ <br /> <br />7. Will the propo~sed structure have any of the following systems? If yes- separate permits are required. <br /> Electrical Y ~/ N Plumbing Y N Heating/Cooling/Ventilation Y N Septic Y <br /> <br />8. Where will restroom facilities be provided? '-'"~c..~ ~.- '~'~..~ <br />9. What is the maximum number of peopte present in the building at any one time during the year? <br /> <br />10. Is this structure used by the public at any time? Y N J <br /> Explain <br /> <br />N <br /> <br />11. What is the distance from the proposed structure to property lines and/or other structures? <br /> Front~.~/ Rear~' Left side~l~~ Right side~Obther <br /> <br />12. This application will not be considered complete without a site plan that includes the size of the building. <br /> **See attached site plan requirements. <br /> <br />I certify that I have read this application and state that the information given is correct. I agree to comply with <br /> <br />DATE <br /> <br />PHONE <br /> <br />and c~:t~y ordinanc~relating to building construction. <br /> <br />~ '~ ~ ~ NAME (Please Print) \ <br /> <br /> CITY STATE/ZIP CODE <br /> <br />MCI5-76-REV 7/97 FOR OFFICE USE ONLY <br />APPROVED DENIED DATE <br /> <br /> <br />