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• <br /> 1 MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG NO.225 <br /> - 220 HIGH STREET NE <br /> SALEM, OREGON 973111 <br /> PHONE 588-5147 <br /> CODE•A•PHONE 4:30 P.M -8.00 A M. <br /> t I am ptxlormulg work pn a IxapeAy I oxn a aca,py <br /> l S I atn a regiatered bulkier OR t t the authorized rapeesentati►s SIGNATURE Or APPLICANT <br /> at a registered Mellor <br /> t ) 7ho work will be performed by a registered buider - <br /> I Ihhave erraad and agree to the terms staled On the reverse side of OArE <br /> tuts doe tmont <br /> DATE: 05/28/89 TIME: 12_49:12p <br /> oNn+ert STANTON, BESSIE Tax Loy cartGcu�v RESIDENTI) <br /> smis AooREss ooromo-noN TYPE occuvna Y <br /> Kt IZE50 OR 97303 N CONTRACT CITY uGe OCOt,aANT LOAD <br /> KEIZER NO <br /> USS Oa Sus D NO OF 5OROous <br /> 3 <br /> MAILING ADDRESS <br /> SUBDIVISION <br /> 4673 HAYESVILLE DR NE S' <br /> SALEM 97305 <br /> PHONE: 393-3480 SITE NUMBER: 7427 <br /> VALUATION: <br /> LOT BLOCK SECTION TOWNSftlP RANGE ZONE um, p <br /> 07M GeC171 AREA UNrr$ 7 I4 REG 1 CORNEA <br /> :7: f <br /> Nn <br /> C? �� NO NO <br /> TYPE: ON—SITE SEWAGE WATER SUPPLY: PW ..... <br /> PERMIT OR APPLICATION NO: 9016280 TEST HOLES READY: <br /> EXISTING TANK SIZE: <br /> CONTRACTOR NO. EXISTING DRAIN FIELD LINES: <br /> STANTON, BESSIE SEPTIC TANK PUMPED: <br /> 4673 HAYESVILLE DR NE PREVIOUS NO. BEDROOMS: <br /> SALE 97305 <br /> PHONE: 393-3480 <br /> EM <br /> EXISTING SYSTEM EVAL. RPT. QUANfI11'Y AMOUNT$100.00 <br /> TOTAL. ASSESSED FEES $100.00 <br /> • PREVIOUS RECEIPTS $0.00 <br /> THIS RECEIPT $100.00 <br /> VALANCE DUB $0.00 <br /> PAYEE: STANTON, BESSIE RECEIPT NO: 17315 <br /> RECEIVED BY: LAM TYPE: CK CHECK U: 738 <br /> SEE ATTACHED DOCUMENT FOR REQUIREMENTS OF CW—SITE SEWAGE system. <br /> * THIS IS NOT A PERMIT. MISAPPLICATION MIST G0 THROUGH A ReifiEw PRocess WHERE THE _— <br /> FOLLOW_ 1-1.!le �ALL /N D. Lj PROVIDED.RESPONSIBILITY OF THE APPLICANT TO ASSt1RE THAT <br /> fA <br /> I PLAN REVIEW: SY HATE 5' {4- CITY JURISDICTION: 8Y DATE <br /> REMARKS: AUTH FOR LOAN m801 <br /> _L.) ti..."-- ....-/---,--)- ,,e-x..a..,.....ej--- -1._... <br /> 7.-412.--e. 4:0 . ....-44.-.=0...41-- <br /> FORM s 16C 10+80 NEv Wee OFFICE COPY <br />