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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 228 <br />220 HIGH, STREET NE <br /> SALEM, OREGON"97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 P,M, - 8:00 A.M. <br /> <br />I arT~ performlnS work on a property I own or occupy, <br />I am a registered builder OR the authorized representative <br /> of a registered builder, <br />The work will be performed by a registered builder, <br />Other. <br /> <br />')ATE: OS/OS/S? 'F [ vi1~: $~40:09~ <br /> <br /> . re,siC, ROBERT' <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE'. <br /> <br /> TAX LOT; <br /> <br /> CONSTRUCTION TYPE: <br /> <br /> 280 CENTER STREET <br />'DETROIT <br /> <br />USE OF BUILDING'. <br /> <br />OR 9?342 i CONTRACT CtTY~ UGB: <br /> <br />SAME <br />¢:>HONE: 854.-375 <br /> <br /> 100 <br /> <br />nAY <br /> <br /> SITE NUIVlSER: <br /> VALUAT!ON: <br /> <br />77 ??00.00 SF N <br /> <br />CATEGORY: <br /> <br />OCCUPANCY: <br /> <br />OCCUPANT LOAD: <br /> <br />1163 <br /> <br /> ~ O5 <br /> <br />TYPE: ON-SITE SEWAGE <br />','>ER~vI/;T OR APPLTCATTON NO:'. <br />CONTRACTOR, <br />MUS]:C, RC)E~ ERT <br /> <br /> I ~4ATER SUPPLY: CM <br /> t TEST HOLES READY; <br /> 9001935 ! SITE EVALUATION NUI',lSER: <br /> EXIST'iNG T~.NK ST~ZE: <br /> EX[ST~NG 0~'A~N FIELD <br /> ~ SEPTIC TANK PUNPED; <br /> [ ..O,.DZN,¢ T~K AGREENENT= <br /> ~SE~ENT: <br /> ~:z '~' = ~ AFFZOA, VZT: <br />PHONE: 8o ~-~ .... ~ <br /> N,N~' Tear WATER CHECK: <br /> <br />REPAIR I;°'* i"0 <br /> <br /> TOTAL ASS~ED FEES $~5.00 <br /> PR~[OUS RECEIPTS $0. <br /> THIS RECEIPT <br /> <br /> BALANCE O,., ~_ $8, <br /> <br /> ................................ _F,~,., ~. 0 <br /> <br />SEE ~TTACHED DOCUF~ENT FOR REQ, ]RENEN~S OF ON-SiTE SEWAGE SYSTEH. <br /> <br />'.:; P~;C i AL REQU <br /> <br />* ~IS <br />FOLL~[NG ~ST BE ~PL~ED_ , IT' IS, ~E" R~S[B[L[TY,OF ~E APPLZC~T TO ~RE ~AT <br />ALL N~ <br /> <br />REMARKS: c .~.P7 t ~ REPAIR <br /> <br />OFFICE COPY <br /> <br /> <br />