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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHC~E 58'6-5147 <br />CODE-A-PHONE 4:30 P.M. - 8:00 A.M, <br /> <br /> of a registered builder, <br /> <br /> ']ATE: 10/05/87 TIME: 10;06;42a <br />OWNER: : TAX LO'f: <br /> 8UTTEV f LLE COiV~UN ITY ~HUCH- i 70380-] 90 <br />SIfUS ADDRESS:---- -- ' ' ,(,~ H- ~L ~'~__(~,~' i CONSTRUCTION TYPE; <br /> <br /> 10848 ARNDT RD NE ;rOONTR*CT CITY'. I' Ue~= <br /> .~C~ ~4~.~N,,.O~PNT¥ I. NO <br /> <br />RESI DEN'T]:AL <br /> 35 <br /> <br />]0858 ARNOT RD NE <br />AURORA~ OREGON 9?002 <br />PHONE: 678-]188 <br /> <br />LOT: OLOCK: <br /> <br />~-~' ; SITE NUIVlBER: 2 ,, 18 <br />'~ : VALUAT I ON: <br /> <br /> 32 3S 1~ AR" <br /> i NO NO <br /> <br />: MAP: <br /> <br />TYPE: ON--SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: 9004775 <br /> <br />CONTRACTOR, NO. <br />BUTTEVILLE COHMUNITY CHUCH <br />10858 ARNDT RD NE <br />AURORA, OREGON 9?002 <br />PHONE~ 678-1188 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATIO¢4 NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: TO BE PUMPED <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM QUANTITY A~fOUNT <br />AUTHORIZATION NOTICE - FLD. VISIT 1 $65,00 <br /> <br /> :TOTAL AE, SESSED FEES $65.00 <br /> ,' 'PREVIOUS RECEIPTS $0-00 <br /> THIS RECEIPT $65.00 <br /> <br /> BALANCE DUE $0,00 <br /> <br />PAYEE: BUTTEVILLE COHMUNITY CHUCP},'~ ~ ,n 'RECEIPT NO: $333 <br />RECEIVED BY' JB ~ /--'-';~- x'~/ TYPE. CA CHECK ~:- 0 <br /> <br />SEE ATTAC~ED DOCUMENT FOR :REQUII:~HENTS DE ON=SITE,:SENAGE,S¥STEN. <br />~ THIS IS NOT A PERNIT. 1HIS APPLICATION f. IUST GO TH~E~ A REV[E-~ PROCESS ~HF_RE THE <br />FOLLOWING MUST BE COMPLETED. $TI$ THE"RESPON~'iB[[ITY OFTHE APPLICANT TO A,.~SURE T~[AT <br />ALL NECESE~RY INFORNATION HAS BEEN PROVIDED; <br /> <br />PLAN REViEN: BY__ _ DATE CITY JURISDICTION: SY ......... <br /> <br />REI~ARKS: USING CHURCH SEPTIC <br /> <br />OFFICECOPY <br /> <br />DA"FE ........... <br /> <br /> <br />