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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> of a registered builder- <br /> The work will be performed by a registered builder. <br /> <br />OATE: 04/17/87 TIME.' 2:41:10p <br /> <br />OWNER; THOMPSON. DAVID <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 P,M, - 8;00 A.M. <br /> <br />TAX LOT; 56352-000 ' BA"CEGORY: R <br /> <br /> 8501 HOLNQUiST ROAD <br />AUfc~VILLE OR <br /> <br />USE OF BUILDING: <br /> <br />MAILING ADDRESS: <br /> <br />¢O 8OX 182 <br />STAYTON. OREGON 9?383 <br />PHONE: NONE <br /> <br />LOT; BLOCK: <br />WIDTH: DEPTH~ <br /> <br /> CONSTRUCTION TYPE: <br />97325 cGN~n~c~ ciYV,. UGe: <br /> <br />:OCCUPANCY; <br /> <br /> OCCUPANT LOAO: <br /> <br /> 3 <br /> <br />SITE NUMBER~ 1120 <br />VALUATION: <br /> <br /> 31 8S 1W AR <br /> <br />AREA; 1 [~OOo0 ] UNiTs;' Ab : lARVa, y N <br /> <br />MAP: <br /> 48 <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PEr4~4IT OR APPLICATION NO: 9001663 <br /> <br />CONTRACTOR, NO. <br />THOMPSON, DAVID <br />PO BOX 182 <br />STAYTON, OREGON 9?383 <br />PHONE: NONE <br /> <br />WATER ,.SUPPLY: PN <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 />AFFIOAVIT~ <br />HINTER WATER CHECK: <br /> <br /> ITFJM <br />PRE, RE DISTRIBUTION <br /> <br />QUANTITY <br /> 1 <br /> <br />TOTAL ASSESSED FEES <br />PREVIO~JS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DUE <br /> <br />PAYEE: THOMPSON, DAVID <br />RECEIVED BY: dm <br /> <br /> INVOICE NO: <br />TYPE: CK CHECK <br /> <br />AMOUNT <br /> $125.00 <br /> <br /> $125_oo <br /> $0.00 <br /> $125.00 <br /> <br /> $0.00 <br /> <br />2153 <br />1'1t6 <br /> <br />SEE ATTACHED DOCUMENT FOR REQUIREMENTS <br />SPECIAL REOUIRB'41~4~S: <br /> <br />~ THIS IS NOT A PER~IT. THIS <br />FOLLOWING NUST BE CONPLETED. <br />ALL NECESSARY INFORM&TION <br /> <br /> ~' DATE <br />PLAN REVIEW: 8Y~ ',, <br /> <br />REMARKS: LOW PRESSURE SYST ,, ';: <br /> <br />SYSTE~. <br /> <br /> PROCESS HERE THE <br />APPLICANT TO AS,~JRE THAT <br /> <br />BY DATE <br /> <br />OFFICE COPY <br /> <br /> <br />