Laserfiche WebLink
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 />I am performing work on a property I own or occupy. T ..~ 5~.~?~ ,~ ~_.. ,) <br />I am a re§istered builder OR ) the authorized representative SIGNATURE OF APPLICA <br />of a registered builder. <br />The work will be performed by a registered builder. <br />Other <br />I Ilave read and agree to the terms stated on the Ceverse Side of DATE~ <br />this document. <br /> <br /> OAI'E: 12/27/91 TiMm- 15:'11:21 <br />OWNER; ~ ' TAX LOT: CATEGORY; <br /> <br /> ~ICPI KE, DEAN <br /> <br />R.b,S I UbN l l A!. <br /> <br /> 8342 BISHOP ROAD <br />AUMSVILLE <br /> <br />GR 9?325 <br /> <br />SE <br /> <br />IV)ARiON COUN¥'Y NC) NO 0F HFOR00MS <br /> <br /> PHONE:: '749""'T3~6 SiI'E NUMBER-' 15279 <br /> VALUA'f iON: <br />LOT: BLOCK: SECTION; TOWNSHIP: RANGE: ZONE: MAp: <br /> <br /> 31 85 1W E:FU 48 <br />WIOTH: ~E PTH: AREA: UNITS: IRREG. LOT: CORNER; <br /> <br /> 3, AC NO NO <br /> <br />!YPE'- ON~-SIYE :3gWAGE WAFER SUPPLY: ~ <br /> 'f'ESf' ~.x,, :.o READY: <br />PERNif OR APPLiCATZON NO: 9037857 S~fE EVAL.UAT~ON NUMBER: <br />, , ~ / EXi~'f'iN~ lANK SIZE; <br />CONf'~O'F'OR, NO .... , /¢, //~ EXISTING 0f~tN F'IELQ LINES: <br />~PlKE, DEAN /) ¢ ~/~//~/' 5EP'flC TANK PLJ~PEO: BRING VER1HY <br /> <br />........ 77EG ........... ................................. __ EF :FTT7 ........... ;;E;G'T .......... <br />REPA <br /> JR ~- ~IAJOR ~ 1 $85_00 <br /> <br />PAYEE: ~¢CP1KE, DEAN <br />Rb, CEiVE[) BY: DM2 <br /> <br />TOTAL A~ESSED FEES $85.08 <br />PREVIOUS RECEi P'f'S $0_ 00 <br />THIS RECEIPT $S5. C~o <br /> <br /> R~(3~iP~ NO: 39536 <br /> TYPE; CK CHECK ~= 5535 <br /> <br /> SEE! A'I [ACHEO DOCU~EN'f' FOR REQUIREMENTS OF ON-SITE SEWAGE SYS'IE]~. <br /> <br />~ THiS IS NOT A PERf~IT. THIS APPLiOATION MUST 60 'rHROU~-t A REVlE~ PROCES~ ~HERE THE <br />FOLLO~IING MUST BE COMPLETED. 1T iS THE RESPONSIBiLiTY OF THE APPLICANT TO ABECJRE THAT <br />ALL NEC~ARY /NFOR]'4ATiON HA~SBEEN PROVIDED. <br /> <br />P[p~,N REV,IEW: BY DA'TE <br /> <br />CITY JURiSDIC'IION: BY [)A'TE <br /> <br />OFFICE COPY <br /> <br /> <br />