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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO 225 <br />220 HIGH STI~EET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8.00 - 4::30 <br />24 HOUR CODE-A-PHONE:: 588-7904 <br /> <br />Other <br /> <br />SIGNATURE ©F APPLICANT <br /> DATE <br /> <br />OW~L~I E: 08/,~ 1/90 TIME: <br /> <br /> DErRoJ.[ ~FAFE PARK <br />51TLS ADDRESS <br /> <br />14:19:30 <br /> <br />TAX LOT <br /> <br />CONSTRUCTION TYPE <br /> <br /> 47 MiLE ~l'. NO SA.NflAM HWY SE <br />DE I'RO~ T OR 9?342 <br /> <br /> CONTRACT CITY <br /> <br />MARION COUNTY <br /> <br />20024 ~iLVER FALLS HWY 5E <br />~¢JBLiM[ [Y OR 9'/385 <br />PHONE: 873-8681 <br /> <br />LOI SLOCK SECTION TOWNSHIP <br /> <br />STTE NU~'~3 ER: <br /> VALUA r tON: <br /> <br />NO <br /> <br />COMM ERC i AL <br /> <br />5943 <br /> <br /> UNITS IRREG LOT CORNER <br />104. AC NO NO <br /> <br />TYPE: ON-SiTE SEWAGE <br /> <br />PERMII OR APPLIOAIION NO: 26426 <br /> <br />CONTRACTOR, NO. <br />DEFROJf Sf~fg PARK <br />20024 SILVER PALLS HWY <br />SUBLiMi[Y OR 9?385 <br />PHONE= 8'/3-8681 <br /> <br />WAlER SUPPLY: <br /> HOLES R~.AUY: <br /> EVALUAIlON NUF~ER: <br /> ~×ISFING FANK SIZE: <br /> EXiSTiNG ORAIN FieLD <br /> ~EPIIC YANK PUMPED: <br /> PRE¥~OUS NO. B~ORO0~s: <br /> <br /> iTEM QUANTIFY A~0UNI <br /> UfO UNSIIg 5YS < ~O0D GAL 1 $160.00 <br /> ADDITIONAL SURCHARGE - SUBSURFACE 1 $5.U0 <br /> <br /> tO'TAL ASSESSED PEE5 $165.00 <br /> PRE¥IOUS RECEIPT'S $165.00 <br /> YHIS RECEiPI $0.00 <br /> <br /> BALANCE DUE $0,00 <br /> <br /> PAYEE: R~CBiPI NO: <br /> RECeiVED BY: CL FYPE: CHECK ~ <br /> <br />~ THIS iS A VALID PEI~4iT * THiS PEi~IiT EXPIRES 360 OAY$ FRO~I iTS I.~.<.<.<.<.<.<.<.<.~UB DATE. iF <br />CONSTRUCTIC¢4 FAIL~ TO REET ALL RE(~JiREMENTS OF STATE L.a¢~ AND f~ARION OCtJNTY BUILDING AND <br />ZONING ORDINANCES. THiS PER,lIT S)HALL BECOME NULL AND VOID. <br /> <br />REMARKS: MAJOR REPAIR R~2744 ~ ~ <br />DONALD ~. WOODLEY, MARiON COUNTY BUILDING OPPiCiAL / BY .............. ~ <br /> <br /> OFFICE COPY <br />FORM # MO ~5-56 REV <br /> <br /> <br />