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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO 225 <br />220 NIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br />PHONE: 588-5147 800 - 4::30 <br />24 HOUR CODE-A-PHONE:: 588-7904 <br />,~'/'[ um performing work on a property I own or occupy ' <br /> I am a registered b dot OR he au hor zed ropresentat~,~e SIGNATURE OF APPLICANT ~Z~-- <br /> Of a registered builder <br /> The work will be performed by a registored builder <br /> <br /> J hace read and agree ~o tee terms stated on the reverse side of DArE <br /> th~s document <br /> <br />ow~¢lE: 05/24/91 fIME~ 14=07:38 <br /> <br /> 1HOMP~ON, ~iCH~EL <br />SI~US ADDRESS <br /> <br />RESi DEN ¥ i ~,L <br /> <br />q9024 WISEACRE LAND NE OONTF~A~.TCiTY UGB <br />AURORA OR 9't001 <br />USE OF BUILDING IVlARION COUN1Y NO <br /> <br /> SAME <br /> PH(~IB,: 6?8-2?66 <br />LOT BLOCK <br /> <br />SECTION TOWNBH <br /> <br />AREA UNITE <br />20580. <br /> <br />SllE NUMBER: 13074 <br />VALUA I iON: <br />RANGE ZONE <br /> <br />IR~EG LOf CORNER <br /> NO NO <br /> <br />MAP <br /> <br />TYPE: ON~I I P.. SEWAGE <br /> <br />PERMIT OR APPLiCATiON NO: <br /> <br />C'ON f ~'~AC f OR, NO. <br /> 1HOMF>,'5ON, MICHAEL <br /> <br />PHONE: 6"f8~2766 <br /> <br />WAFER EAJPPLY: PW <br />~E5[ HOLg5 READY: <br />BIlE EVALUAIlON NUMBER; <br />EXISFiNG 'lANK SIZE: <br />E. Xi~TiNG DRAIN FIELD LINES: <br />SEPIiC I'ANK PUMPED: FORJ~I GIVEN <br />PREVIOUS NO_ <br /> <br />AUfHORiLAFiON NOI'ICE - FLD. VlSI <br /> <br />PAYEE: fHOMf~"JON, MiG'HA~L <br /> <br />IOIAL ~E~,SED PEE5 <br />PRE¥IOU5 RECEiPf'S <br /> <br />QUANIlfY AMOUN] <br /> 1 $~o5.oo <br /> <br />$105,00 <br /> $0.oo <br />$10b.00 <br /> <br />BALANCE DUE $0.00 <br /> <br />34253 <br /> <br />246 <br /> <br />~ THiS iS NOT A PERI~IT. THIS APPLICATION f~t.l~T GO THROU(~I A REVlE~I Pt~OCE~x5 I. HERE THE <br />P'OLLQ~NG I~UST 8E ~PLETED. IT iS THE R~S[SIL/TY OF THE APPLI~T TO ~ THAT <br />ALL N~RY iN~Ti~ H~ 8E~ P~VIOEO. [ <br /> <br /> P~ REVIEW: BY ...... 5DlCfi~: BY DAlE <br /> REMARKS:~ AUiH ~6~42~ / ~ ...... ...... <br /> <br />OFFICE COPY <br /> <br /> <br />