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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <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 />of a registered builder, . <br />O~her <br /> <br /> I have read and agree to the terms stated on the Ceverse side of <br /> <br />DATE: 04/24-/8? TTME: <br /> <br /> THOMPSON, DAVID <br /> <br />S~TUB ADDRESS: <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> DATE~ <br /> <br /> TAX LOT: <br /> 55362-000 <br /> <br /> CONSTRUCTION TYPE: <br /> <br /> 850] HOLMQUIST ROAD SE <br />AUMSVILLE OR 97325 <br /> <br />USE OF ~bl£diNd'; .......... <br /> <br />CONTRACT CITY: UGB. <br /> <br />BUBCIVISION: <br /> <br /> PO 8OX 182 <br /> STAYTON, OREGON 97383 <br /> PHONE: NONE <br /> <br />LOT BLOCK: , S~CTION: TOWNSHIP: <br /> $1 <br />WIDTH BEPTH: 'AREA: 'UNITS <br /> 1.50000, <br /> <br />CATEGORY: <br /> <br />OCCUPANCY. <br /> <br />OCCUPANT LOAD <br /> <br />No OF BEOROOME <br /> <br /> SITE NUMBER= 1120 <br /> VALUATT ON: <br /> <br /> RANGE ZONE; MAP' <br />9 S '1 N A R <br /> RREG. LOT'. CORNER: <br />AC <br /> <br />TYPE: ON'SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO~ 1663 <br /> <br />CONTRACTOR, NO. <br />THOMPSON, DAVZD <br />PO 8OX 182 <br />STAYTON, OREGON 9?383 <br />PHONE: NONE <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: 83-1949 <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />HOLDING TANK AGREEMENT: <br />EASEMENT: <br />AFFIDAVIT: <br />WINTER WATER CHECK: <br /> <br /> ITEM QUANTITY AMOUNT <br />PRESSURE DISTRIBUTION '! $125.00 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$125.00 <br />$125.00 <br /> $o,oo <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: iNVOICE NO: <br />RECEIVED BY: P8 TYPE: CHECK <br /> <br />SEE ATTACHED DOCUMENT FOR S~STEM. <br /> <br />SPECIAL REQUIREMENTS: <br /> <br />* THIS IS A VALID PEI~IlT * <br />CONSTRUCTION FALLS TO NEET <br />ZONING ORDINANCES, THIS <br /> <br />ITS ISSUE DATE. IF <br />I~IARION COUNTY BUILDING AND <br /> <br />REMARKsz LOW PRE~SURE <br />DONALD E. NOODLE'F,, MARION <br /> <br />OFFICE COPY <br /> <br /> <br />