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MARION COUNTY BUILDING INSPECTION <br />SENATORBLOG NO 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PH~O N E 588-5147 <br /> CODE-A-PHONE 4:30 PM, - 8::00 A,M <br /> <br /> I 8m performing work On a property I own or occupy <br /> l am a registered builder OR ( ) the authorized representative <br /> at a registered broider <br /> The ¢~ork will be performed by a registered builder <br /> Other <br /> <br />DATE: 01/05/88 TIME: 10:04.+52a <br /> SMITH, TERRY <br /> <br /> 4767 DUMORE DR SE <br />AUMSVILLE 9?325 <br /> <br />USE OF EcUILglNG <br /> <br />OR <br /> <br />MAILING ADDRESS <br /> <br />1335 RCF3ENAY CT SE <br />SALEM 9?302 <br />PHONE: 3?8-4000 <br /> <br />LOT BLOCK <br /> 4 1 <br /> <br />TAX LOT <br /> <br /> ~0NsTF!UGTION YYf~E <br /> <br />i GONTRAC~' CITY ( tJGg <br />Lv~,~;Pbi..COUNT¥ .; NO <br /> <br />' SU BDIVISIO~' <br /> CASCADE PARK <br /> <br />CATEGORY <br /> RESI DENT I AL_ <br />OCCUPANCY <br /> <br />; OCCUPANT LOAD <br /> <br /> ~ SITE NUMBER: 1577 <br /> VALUATION: <br />ISECTIO'N TOWN~HI~ ..... ~ RANG'E ! ZONE MAP <br /> <br /> 12 8S 2W I AR5 82.5 <br />iAREA UNIT$ IRREG LOT iCOR~R <br /> 3+00000 ~ AC NO [ NO <br /> <br />TYPE; ON-SITE SEWAGE <br /> <br />PERNIT OR APPLICATION NO; 90081?4 <br /> <br />CONTRACTOR, NO, <br />SMITH, TERRY <br />1335 ROSEWAY CT SE <br />gALEN 9?302 <br />PHONE; 3?8-4000 <br /> <br />WATER SUPPLY: PN <br />TEST HOLE.~ READY: <br />SITE EVALUATION NUMBER: 1-16-74 <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO+ BEDROOHS: <br /> <br /> ITEM <br />STANDARD ON-SITE SYSTEM <br /> <br /> QUANTITY AMOUNT <br /> 1 $125.00 <br /> <br /> TOTAL .A, SSES~ED FEES $125_00 <br /> PREVIOUS RECEIPTS $0.00 <br /> THIS RECEIPT $125.00 <br /> <br /> BALANCE DUE $0.00 <br />PAYEE: S~IlTH, TERRY ~ : /"2 ~ , : RECEIPT NO: 6760 <br /> <br />*THIS IS NOT A PERNIT. THIS APPLICATIONf4d~TGOTHR~t.I(~"'IAR'c~flEN~I~4ERETHE <br />FOLI_(;~INGI~I.~T BE COFIPLETED. IT Isi'HE RESpONSIgiLI~OF~E APPLICANT TOASSURE'fHAT <br />ALL NECESSARY IN~TION H/~ BEEN PROVIDED. <br /> <br />REI'CC, RKSt SEPTIC R~8843 <br /> <br />CITY JURISDICTION. <br /> <br />DATE ........... <br /> <br />rO~M r' MC ~S 5~ ~V ~,8~ OFFICE COPY <br /> <br /> <br />