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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 8m Berforming work on aproperty I own of occupy, <br />I am a reglsteredbuJlderOFf( ) the authorized representative <br />of 8 registered builder. <br />The work will be performed by 8 registered builder. <br /> <br />°w~:l'E: Q9/2'i/90 f'i~E: 13:28:26 <br /> <br />BITUB ACDRESr~ANDY P'UL1'Z CONS'~ RUC'T"[ON <br /> <br />TAX LOT CATEGORY <br />CONSTRUCTION TYRE: OCCUPANCY' <br /> <br />RESt~)ENTiAL. <br /> <br />5983 WAL[NA COURT SE <br /> <br />MAILING ADDRESS; <br /> <br />CONTRACT CITY: ' OGB; OOCUPANT LOAD <br /> <br />M~RiON COUNTY NO ,0 0¢ ¢~0o,4s <br /> <br /> SUBDIVISION <br /> 3 <br /> <br /> ROLLING GREEN E~fA'f'ES WESf' <br /> <br /> PHC1'4 E: '/(59-5386 <br />LOT'BLOCK SECTION TOWNSH rF~ <br /> <br />MAP: <br /> <br />! r~.l,j ¢. 13 <br /> <br />8S IRREG. LOT: 2W CORNER: AR <br />'"'~'" Yi;~S ~JO <br /> <br />4g <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMi'f OR APPLICATION NO: <br /> <br />CONTRACTOR, NO_ <br />RANDY FUL'f'Z C~NB'f'K~C'TION <br /> <br />PHONE= 769~5385 <br /> <br />26758 <br /> <br />NATER ~UPPLY: PW <br />TEST HOLES READY~ <br />SITE EYALUA'I'iON NUr48ER: 25~57 <br />F..~(IS'f'iNG TANK SIZE= <br />~STiNG DRAJN ~JEL0 LINES: <br />SEPTIC TANK PU~PED: <br />PREWIOUS NO, BEBRC~)NS: <br /> <br /> ! ~' EIv~ QUAN I i "['Y A~4OUN f <br />~E < 6 ~ONTH~ OLD 'f $']10.(00 <br /> <br />TOTAL ~ES~ED FEES <br />PREVI6~J$ RECEIPf'S <br />]'HIS RECEIPT <br /> <br />~ ~ / O. O0 <br />$110_00 <br /> ~,,;. 00 <br /> <br />BALANCE ~tJE $0.00 <br /> <br />PAYEE: REfJP,':i P T' NO: <br /> <br /> RECEIVED 8¥: P~ ............................................................................................ TYPE.' (.,IIE(;;K :~'¢: 0 <br /> ~5~±~ A'T'fAOtd~O B(TCUMEN')" FOR ~;(;,iIJIREMEN'f'S OF O~-SI'f'E <br /> <br /> · THIS 1S a VALID PE~iT* THIS PE~iT ~P[R~ 360 ~ FR~ iTS [~g ~I'E. IF' <br />~S'I'~UC'I'~ P'~i~S TO EET ~' IR T~ OF S'rATE ~ ~D ~Ri~ O~N'I'Y BU~LDiN6 AND <br /> ~iNG ORDINANCES, THi~ PE~ ~L ~E NULE ~D VOID. <br /> <br />RE'IV~,RKB: ~'I'D SYSTEM R~t3994 <br /> <br />OONALD g, WOOOLEY, MARION COUNTY ~3UiLDiNG OP'P~C~,AL / <br /> <br />OF FICE COPY <br /> <br /> <br />