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3150 LANCASTER DR NE. SUITE C <br />__ SALEM OREGON 97305 503-S88-5147 <br /> <br />[~ ~ ri ~ 17 I:l'~,~ICATION FOR EXEMPT STATUS FROM THE STRUCTURAL sPECl4tqCi~0~crt0UNTY <br /> ~ ~ I~___~ U ~/I'~11 }J' FOR AN AGRICULTURAL BUILDING ON A COMMERCIAL IIIUI~BIN$ INSPEOTION <br /> <br /> A i LOCATION: <br /> <br /> MARION Nd-' WNEm <br />BUILDING IN.ION <br /> ~,./),~"//.ffBUILDING SITE ACRES. <br /> <br /> 1. <br /> <br />Is this property classified by the Assessor as farm deferred? <br /> <br />TOTAL# OF ACRES FARMED: <br /> <br />2, Are you located within the Urban Growth Boundary? Y N ~ <br />3. <br /> <br />BE SPECIFIC in describing your commercial farm enterprise, size of operation, and annual profit. 4L,:pp[~cable, <br />provide proof of farm income for the last three (3) years. <br /> <br />5. What is the size ol the proposed building? LENGTH~,'~ WIDTH <br /> <br />6. Is the proposed structure located within a flo~ plain? Y N <br /> <br />7. Will the proposed structure have any of the'following systems~ If y~- s~arate permi~ are required. <br /> Electrical Y ~ N Plumbing Y N ~ Heatin~Coolin~entilation Y N <br /> <br />8. Where will restroom facilities~e provided? N ~ <br /> <br />9. What is the maximum number of people 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 <br /> Explain <br /> <br />11. What is the distance from the proposed structure t~and/or other structures~ <br /> Front ~.00'~ Rear ~01DO4:4' Left stdel~.~¥ Right sid~l~,qOther <br /> <br />12. This application will not be considered complete without a'site plan that incluc]es 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 />all state laws and county ordiqances relating to building construction. <br /> <br />SIGNATURE <br /> <br />DATE <br /> <br />PHON~ ~ CITY <br /> MC15-76-R~V 7197 ~R OFFICE USff ONLY <br /> APPROVED DENIED <br /> <br />NAME (Please Print) <br /> <br />STREET ADDRESS <br /> <br /> STATE/ZIP CODE <br /> <br />DATE <br /> <br /> <br />