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MARION COUNTY BUILDING INSPECTION <br />SENATORBLDG 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 /> of a registered builder, <br /> <br /> Other <br /> <br />DATE: ]1/20/91 TIME: <br /> <br /> B,aK,k.R, ROBERi ~ CHRt~¥INE <br /> <br />SIGNATURE OF APPLICANT <br /> OATE <br /> <br /> TAX LOT <br /> <br /> 9263 ,c-hORTER RD Sg CONTgAE. T CITY <br />AUM.SVI LLE OR 8'¢325 <br /> MARION CXDUN I Y <br /> <br />USE OF BUILDING <br /> <br />UGB <br /> <br />SUgSIVISION <br /> <br />NO <br /> <br />CATEGORY <br /> RESi DEN T fAL <br /> <br />OCCUPANT LOAD <br /> <br />NO OF BEDROOMS <br /> <br /> PItONE: ~49-2566 <br />LOT BL. OCK SECTION TOWNSHIP <br /> <br /> S,[TE NUMBER_' bb45 <br /> VALUA f ,[ON: <br /> <br />DS 2l,~ EPU <br /> IRREG LOT CORNER <br /> NO <br /> <br />MAP <br /> <br /> IYPE: (~-51fE 5~'WAGE <br /> <br />PERMIT OR APPL,[CAIION NO: <br /> <br />CONfRACFOR, NO. <br />MAKER, R(:.~Rf & CHRiSf,[Ng <br /> <br />PHONE: <br /> <br />t4274 <br /> <br />WAfbR SUPPLY: <br />TESI HOLES RgADY: <br />SITE EVALUAf,[ON NUMBER: <br />EXiSTiNG 'TANK 5iZE: 900 <br />EX1SflNG DRAIN FIELD LINES: <br />SEPIIC TANK PUMPED: BEING DONE <br />PR~¥iODS NO. BED--S: 2 <br /> <br /> II'EM QUANTiIY AMOUNI <br /> ACDIIJ(~AL ,SUSSURFACE FEES 1 <br /> <br /> IOIAL ASSESSED FEE5 ~105.00 <br /> DREWIOUS RECEI P'f'S $ <br /> fHl5 RECE,[PI <br /> <br /> BALANCE DUE <br /> <br /> PAYEE: RECEiPI NO: <br /> RECEIVED BY: OM2 FYPg: C~ECK ~: 0 <br /> <br /> SEE ATTACHED DOCUMENT ?OR RE(c1~JIREI','IENrS OF ON-SiTE SEWAGE <br /> <br />~ THIS IS A VALID PE~iT * THiS PERiYIiT EXPIRES 360 DAYS FRO~ ITS i~E DATE. <br />gY..~SfBOTI~ FALLS TO MEET ALL RE(L~UIRiE~ENTS OF ~TATE LAiNIS AND fVlARION COUNTY BUILDING AND <br />ZONING ORDINANCES, THiS P£F'~'~IiT .SHALL BECO~IE NULL AND VOLS. <br /> <br />REMARKS. EXIST 5YSI' AUIH NOI~ELD V~ R~ 5519 <br /> <br />liJONAL~ E:, WOODLEY, MARION COUNIY BUILDING OFFICIAL / BY <br /> <br />OFFICE COPY <br /> <br /> <br />