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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 />Iarn performing work on a property I own o¢ occupy N~T.~....~ <br />I am 8 reft S ered bu der OR ( I the authorized replesentative SIGNATURE OF APPLiCA <br />Of a registered budder <br />7he work ¢,ill be performed by a registered builder <br />Other_ <br />I have roBd and agree to the terms stated on the reverse side of PATE <br />th~s document <br /> <br />ow~lE: 10/05/90 Fillet 12:56:50 <br /> <br />$1TUSAi:>DRES['~I(:-HOL, GLEN E. <br /> <br />8'~20 HOLMQUiSf R0 <br />AUffi~Vi LLE <br />USE OF BUfLDINFJ <br /> <br />OR 97325 <br /> <br />CONTRACT CITY UGS <br />MARION COUNTY NO <br /> <br />OCCUPANT LOAP <br /> <br /> NO 0¢ BED~00M!; <br /> <br /> 9?48 BA/IES RD SE <br /> AJJMSVILLE, OR 9?325 <br /> f--1-~ON E: 585--1'/82 <br /> <br />LOT BLOCK <br /> <br /> SiIE NUIVC3ER: 11405 <br /> SECTION TOWNSHIP RAN~.,EALUA f ION ~ ZONE <br /> <br />!AREA ~ UNITS 8~ iRRE~ LO~ q~ CORNER A~ <br /> 1.77 ~ Y~ NO <br /> <br />MA*p <br /> <br />IYPE: ON-SI l~, SEWAGE <br /> <br />PERMII OR APPLiCAIION NO: <br /> <br /> 9027812 <br /> <br />DON I-RAC1 OR, NO_ <br />NiCHOL, GLEN E. / <br />9748 BALES RD 5E <br />AUMSVI LLE, OR 97325 <br />~ON~: 585-1782 <br /> <br />NA'IER ~UPPLY: PW <br />l~f HOLES READY: READY <br />~i1E EVALUAIiON NDMFgER: <br />EXI:S'rING TANK SIZE: <br />~iSfJNG 0RAIN F~ELD LINES: <br />SEPtiC rANK PU~PED: <br />PREVIOUS NO. BEO~: <br /> <br />S.'[IE, EVALUAIiON, Fir'<'<31 LOI <br /> <br />PA,.Y,E~': NiCHOL, (~r/~E_/ <br /> <br />FGTAL A.~,~ED PE~ <br />PRE¥iOUS RECEIP1S <br />FH[S RECE£P'f' <br /> <br />~LJJfNNfIIY AI'cF,3UN? <br /> 1 <br /> <br />$1'/5.00 <br /> $0.0u <br />$175.00 <br /> <br />BALANCE DUE $0.00 <br /> <br />RECEIPT NO: 29403 <br />lYRE: OK C'HEC'K ~: 0 <br /> <br />SEE AIIACHBD LYJCUMgNt FOR REQUiREMEN I'G OF (,)N-SiTE SEWAGE SYSIEM. <br /> <br /> NOTE: THIS OOES NOT GI~,NT OR iMPLY PERMi.~SiON TO BUILD ~ THIS PANEL. P~NING <br />C~BFRUCTi~p~N PE~I'I'S~,~T/~ BE ~IAi~Di~ ,¢. ~BEFORE BUILDING OR SEPTIC 1N~IAL~TI~ BEGINS. <br /> RgV/EW: BY. ~ , DA'rE [~ t~"~. OIlY JDRiSDiCiION: BY DAlE <br /> <br /> R~M,,RKS: 8~'~'8 EV,AL R~3329 <br /> <br />OFFICE COPY <br /> <br /> <br />