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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 PM - 8::00 A M <br /> <br />I am performing ¢~ork on a property I own or occupy' <br />I am a registered builder OR ( } the authorized ropre~entatwe <br />Ct a registered budder <br />The work will be performed by a registered builder <br />Other <br />I have read and agree to the terms stated on the reverse Side Of <br /> <br />SIGNATURE OF APPL I('&NT . <br /> DATE <br /> <br />ow~,TE: 08/'~ 7/89 TIME~ 8:40:21a <br /> <br /> DETROIT STATE PARK <br />SITUS &DDRESS <br /> <br /> ,47 MILE POST, NO SANTIAM HWY SE <br /> ,, TROIT OR 97342 <br />USE OF BUILD~NG <br /> <br />rvl4RION COUNTY <br /> <br />MAILING ADDRFSS .... <br /> <br />NO <br /> <br />COMRIERC I AL <br /> <br />20024 SILVER FALLS HWY SE <br />SUSCIMIZW OR 97385 <br />PHONE: 873-8681 <br /> <br /> TOWNSHIP <br /> <br />104.090 <br /> <br /> SITE NLJMBER: <br /> VALUATION: <br />RANGE <br /> <br />!0 I~s LOT SE <br /> <br />ZONE <br /> <br />5943 <br /> <br />NO <br /> <br />MAP <br /> <br />TYPE: ON-SIT~ oENAG,.: <br /> <br />PERMIT OR /~PPL!CAT~'ON NO: 1~159 <br /> <br />CONTRACTOR, NO, <br />DE'~ROIT STATE PARK <br />29024 SILVER FALLS HWY SE <br />SUBLIMITY OR 9'7385 <br />PNONE t 873-8681 <br /> <br />WATER SUPPLY: CW <br />TEST HOLES READY; <br />SITE EVALUC, T]'ON NU¢CBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN F~ELD LINES: <br />SEPTIC TANK PUIV~PED-- <br />PREVIOUS NO. BEDROOVlS: <br /> <br /> I T EM QI ANT ] Th/ AMOL NT <br />:3'fD ONSiTE SYS <:: 1000 GAL ! $!55_90 <br />C & R EACH ADDL. E00 GAL E:c..~F 2 $20,00 <br /> <br /> TOTAL ASSESSED FEES $185.00 <br /> PREVIOUS RECEIPTS $~9~ u~ <br /> THIS RECEIPT $0_00 <br /> <br /> 8&LANCE DUE SO,u, <br /> <br />P~YEE: RECEIPT NO: <br />RECEiVED BY: c] TYRE= CNECK ~: <br /> <br />SEE ATTACHED DOCUNEN-F FOR REQUiRENENTS OF ON-SITE S~WAGE SYSTE~ <br /> <br />~ THiS IS A VALIB PER~IT ~ THIS PERNIT EXPIRES 360 DAYS FRON ITS ISSUE DATE. tF <br />CONST~CTION FAILS TO NEET ALL REqUIRENENTS OF STATE LAWS ,¢~4D NARION COUNTY BUILDING AND <br />ZONING ORBINANCES, THIS PERffiIT .SHALL 8ECOf4E NULL AND VOID. <br /> <br />REfVt~,RKS,_ SERVES 22 ~fRAILER SITES R~7918 REPAIR- LOOP ::G': <br />0ONALD E. WOODt.,EY', MARION CO%Ji',lTY 8UILOING O~'FTCIAL / ~Y <br /> <br /> <br />