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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLOC, 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 /> I have ~ead and agree to the term8 statod dn the revorse side of <br /> <br />DATE.- 11/08/88 TIME: <br /> <br /> DETROIT STATE PARK <br /> <br />TAX LOT <br /> <br /> 4? MILE POST. NO SANTIAb.1 HW'¢ SE <br />DETROIT OR 9?342 <br /> <br />CONTRACT CITY UGR <br />MARION COUNTY NO <br /> <br />20024 SILVER FALLS HWY SE <br />SUBLIMITY OR 9?385 <br />PHONE: 873-8681 <br /> <br />LOT BLOCK SECTION TOW NSC'lip <br />3 <br /> <br /> 104. 000 <br /> <br /> SITE NUMBER: <br /> VALUAT ION: <br /> <br />10 SE <br /> IRREG LO1 <br />AC NO <br /> <br />RESIDENTIAL <br /> <br />OCCUPANT LOAD <br /> <br /> 11 <br /> <br /> 5943 <br /> <br />CORNbH <br /> NO <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO; <br /> <br />CONTRACTOR, NO. <br />DETROIT STATE PARK <br />20024 SILVER FALLS HWY SE <br />SUBLIMITY OR 9?385 <br />PHONE; 873-8681 <br /> <br />9012386 <br /> <br />WATER SUPPLY: PN <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES.- <br />SEPTIC TANK PUMPED.- <br />PREVIOUS NO. BEDROONS: <br /> <br /> i TEM 0UANT I TV AMOUNT <br />AUTHORIZATION NOTICE - FLD. 'VISIT 1 $105_00 <br /> <br /> TOTAL ASSESSED FEES $105.00 <br /> PREV ];OUS RECEIPTS $0.00 <br /> THIS RECEIPT $0,00 <br /> <br /> BALANCE DUE $105.00 <br /> <br />PAYEE: RECEIPT NO; <br />RECEIVED BY: PB TYPE** CHECK ~: <br /> <br />SEE ATTACHED DOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SY,~TEM. <br /> <br />~ THIS IS NOT A PERf4IT. THIS APPLICATION NUST GO THR0tJGH A REVI~N PROCESS WHERE THE <br />FOLLOWIN6 MUST 8E COHPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORMATION HAS BEEN PROVIDED. <br /> <br /> /-- <br />RENARKS: AUTN <br /> <br />OFFICE COPY <br /> <br /> <br />