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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 />SIGNATUBE OF APPl ICANT <br /> DA'T E <br /> <br /> 8~64 ~HAW ~JARE RD <br />AUCA~V l LLE OR <br /> <br /> TAX LOT <br /> <br /> CONSTRUCTION TYPE <br /> <br /> CONTRACT CITY <br />MARION COUNTY <br /> <br />SUBDIVISION <br /> <br />dGB <br /> NO <br /> <br /> RE%ID~NTIAL <br /> <br />OCCUPANCY <br /> <br />OCCUPANT LOAD <br /> <br /> $ <br /> <br />RHONE: 749--2452 <br /> <br /> TOWNSHIP <br />24 <br /> <br /> ~iIE NUMBER: 5982 <br /> VALUATION: <br /> <br /> RANGE ZONE <br />8S 2W AR3 <br /> <br />AC IRREG LOI NO CORNE~O <br /> <br />MAP <br /> <br />l YPE: ON-~.:I TE SEWAGE <br /> <br />CON[RACIOR, N0. <br />[.,ARONE~4, SfEVEN & CARLA <br /> <br />WAIER ~UPPgY; <br /> f~Sf HOLES REAOY~ <br />SIIE EVALUAIiON NUttiER: <br />EXISFING TANK SIZE: <br />~ISTiNG DRAIN FieLD LINES: <br />SEPTIC TANK PUMPED; <br />PREVIQU~ NO. BEOR00~S: 2 <br /> <br />ALJfHORIZAfiON NOT[CF: - NTt) VJ~Jf,~ i $60.09 <br />.O~ TOIAL A.~E~ED PEES $60.00 <br />~/~ PRE¥IOU~ R~CEIPf'S <br /> <br /> ~'BALANCB 0U~ $ . · <br /> PAYEE' GARDNEN, SLOVEN & CARLA ~ ~ <br /> IRECEIVED BY: ONI ~-' <br /> <br /> ~k AffACHEG DOCUMENT FOR R~QUiR~,I~I$ OF GN-SiTE 5E~ACE ~YSrE~. <br /> <br /> ~ ~HiS IS NOT A PEI~41T. THIS APPLiCATiON ~ST <br />FOLL~ING ~5] BE ~PL~'~D. iT iS THE R~SIBILITY OF '~E APPLIC~T TO ~RE IHAT <br />ALL NEC~ARY INFO~TI~ H~ 8~ <br /> <br /> 9L_AN ~<~Vt~W: ~Y OAI~ ~ CITY JURISBICflON: ~Y OAf~ <br /> R~I~ARK5: ALJ T H <br /> <br />OFFICE COPY <br /> <br /> <br />