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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 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE; 588-7904 <br /> <br />I am a registered builder OR ( ) the authorized representative SJGNATUPE OF APPLICANT: <br />of a registered builder. <br />The work will be performed bY a registered buiTder. <br />Other_ <br />I have read and agree to the terms stated on the reverse side of DATEZ <br />this dOCument <br /> <br />owe.~:r E = 0?/05/90 <br />SITUS ADDRES~?UTHE j' 'l', <br /> <br />RICHARD <br /> <br /> 5983 WALINA COURT <br />AUM~VILLE <br /> <br />TAX LOT: <br /> <br />CONSTRUCTION TYPE: <br /> <br />CATEGORY: <br /> <br />OCCUPANCY: <br /> <br />RESiDENTiAL <br /> <br />0~97825 <br /> <br />SE <br /> <br />; CONTRPOTCiTY: : uGg; <br /> <br />MAILING AgDRESS: <br /> <br />ROLglNG GREEN ESTATES WES'f <br /> <br /> (58:~0 SUNSET WAY <br /> TURNER, OR 97:~92 <br /> PHONE: ?43-2?23 <br />t,OT' BLOCK: <br /> <br />~t2 <br /> <br /> 51'T'E NUIN~ER: 10585 <br />':SECTION; TOWNSHIP: ', PAN~.LLtAT ir''~'N: ' ZONE; MAP: <br /> <br />LOT: 2W CORNER: AR 49 <br /> <br />T'YPE: ON-SITE SEWAGE WA',r, ER r:~C, JPPLY: <br /> TEST HO LS.L~ <br />PERMi"F OR APPLICATION NO: 9825357 SiTE E"'FALUATION <br /> E}(IS'I'iN~ TANK SIZE: <br />COhNTRACTOR, NO. ~EXISTiNG DRAIN FIELD LiN~S: <br />STUTHEiT, RICHARD ,.~'~ SEpT'rD TANK PUMPED.* <br />8830 5UNEE'~ WAY ~'l~"' PRE~/iOUS NO. ~ED~: <br />TURNER, OR 97392 <br />PHONE: '/43~,272~ <br /> <br /> i ¥' EM 0UAN T 1 ¥'Y Air'tUN; <br />SiTE I~VALUAfiON, F:IF~:5'f LOT 1 $175.00 <br /> <br /> TOTAL ~E~EP FEES $175. O0 <br /> PR6Wi~5 RECEt~T~ $0.00 <br /> l'HiS RECEIPT $175.00 <br /> <br /> BA~CE ~E $0.00 <br /> <br />PAYEE: 5fU'lHEl'f, RICHARD RECEIPT NOt 2~855 <br />RECEIVED BY: ~2 TYPE: CK ~ECK ~: 149 <br /> <br />SEE A'I~ACHED ~UMEN'f' FOR R~iR~TS OF ~-$1'rE SEWAGE SYS'f'~. <br /> <br /> NOTE: THI.5 DOE5 NOT,~.RANT II~'LY PEI~.lI~.$10N TO BUI~ ~ THIS PA~L. P~NIN6 ~D <br />~5T~CTI~ PE~IT~/~T BE ~TAIN~... ~8E~RE BUILDING OR SEPTIC INSTAL~TI~ BEGINS. <br /> PLAN REVIEW: BY ............ ~ .......... OA'rE.._.l..T~.,l~,~...~ ...... CiTY JURISOiC'f'i~: BY ........................... DATE <br /> RE~RKE~ SiTE EVALUA'J'i~ ~3577 <br /> <br />OFFICE COPY <br /> <br /> <br />