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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 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />t am a registered builder OR ( ) the authorized representative SIGNATURE OF APP~.[CAN <br />of a registered builder, <br />The work w}ll be performed by a registered builder, <br />OtheE <br />I have read and agree to the terms stated on the reverse side of DATE; <br />this dorumenL <br /> <br />OWN~'f'E-' 02/07/91 f'I~5: <br /> <br /> LAIVISREC~' 'f', OELMER <br />SITUS AIDDRESS' <br /> <br />12:t1:27 <br /> <br />fAX LOT: CATEGOR1 <br />;ONSTRUCTION TYPE OCCUPANCY <br /> <br />RESJ OEN f' l/L <br /> <br /> 5336 ANDERSON RD <br />AUrC~V,!; LLE <br /> <br />OR M'fL~2b <br /> <br />CONTRACT CITY UGB OCCUPANT LOAD <br />Ig'c(Ri~IN'O~OUN'f'Y" NO NO 0~ <br /> <br />~AME <br /> <br /> PHONE: ?69-2204 <br />LOT: gLOCE' SECTION TOWNSHIP <br /> <br /> 25. <br /> <br /> SiTE <br /> VALUAT iON <br /> <br />AC NO NO <br /> <br />48O <br /> <br />I'YPE: ON-SITE ,~EWAGE <br />PERNI'I' OR APPLICAI'ION NO.' 9030238 <br /> <br />CONTRACTOR, NO. <br />LAMBRECH]', O~LMER <br /> <br />PH~E: 769~2204 <br /> <br />WATER ;SUPPLY= P~N <br />'FE~'F HOLES REAOY-- <br />S,I;TE EVALUATION NUIV~ER: <br />E}<ISI'ING i"A.NK SIZE: <br />E}<ISTING DRAIN Fi'ELD LiNES: <br /> <br />PREVIOUS NO. E1EOROOIV~: <br /> <br /> i fEN 0LIAN'f'I TY AMOUNi" <br />ANNUAL EYAL. - 'FEMP OR HOSHP IVlH 1 <br /> <br /> TOTAL ~E~E~ED FEES $60.00 <br /> PREVIOUS RECEIPTS $0- O0 <br /> THiS RECEIPT $60.00 <br /> <br /> BALANCE f,,~E $0-00 <br />PAYEE= L.~ClBRECH'i", OELMER RECEiP]' NO: <br />RECEIVED BY: CL TYPE: OK CHTECK ~: 794 <br /> <br />SEE A'f"f'ACHED DOCUMf~N'f' FOR REF,,~IJ!REI"48;N'f'S OF ON-SiTE SEWA(3E sYs'rf~. <br /> <br />* THiS 1S NOT A PER, lIT. THiS APPLICATION rc/JST ~ THROU(~H A REVIb]N PREX~ WHERE THE <br />FOLLOWING tvIUST 8E COK,1PLET~O. iT IS THE RIgSPON~JB~LITY OF THE APPLICANT TO A,..~AJRE THAT <br />ALL NE. CE~RY INFOR~IATION H~ BEENE PROVIDED. <br /> <br />REMARKS; H~P AUTH Z BD~V;~ EA UNiT R~4955 <br /> <br />CITY JURISOICTION.· BY OA'T'E <br /> <br />FORM # MC ~ ~.§¢~ R~V, 4/90 OFFICE COPY <br /> <br /> <br />