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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 /> "lam erformln workona to'err io:~eHr~OccUuR~cODE'A-PHONE;588'7904 <br />~ T~:~or~ will be performed by a r~¢ister, d b.tlder, <br /> ) I h~ve re~d 5~ ~gree to the t~rms stated on [ne reverse side ¢ DATE <br /> this document, <br /> DA'FE~ 05/28/92 'r~ME: 11 <br /> <br /> O~ER: HA~KJN~' ~ERi"J 'JR'J' ' ~x ~or ?10500?2 <br /> <br />SITUS ADDRESS', CONSTRUCTION TYPE <br /> <br /> 11354 JAf4E~ HAY BE <br /> AUM~V,[ LLE OR 9?325 db'NfRA~T' ~ifY: ' <br /> IV)A,R i ON O~NTY <br /> <br /> SO0 SW Vl~')' DR <br /> PORTLAND, OR 97225 <br /> PHONE; 3?1~B483 <br /> <br />WIDTH' ~S~PTH <br /> <br />........... SdEiDIVISION <br /> <br />NO <br /> <br />511'g NUMBER: 92w02014 <br /> VALUAT iON: <br /> <br />:FYPE: ON-SiTE SEWAGE <br /> <br />SECTION TOWNSHIP. ~ANGE ZONE <br /> 29 85 1~ <br /> <br />PE~i'I' OR APPLICATION NO: <br /> <br />CATEGORY; RE~[ f3ENT IAt <br />OCCUPANCY: <br /> <br />OCCUPANT LOAD <br /> <br />CONTRACTOR, NO. · <br />HAWKINS , ROBERT J JR. <br />600 ~ Vi~l' DR <br />PORTLAND, OR 97225 <br />PHONE: 3'? lw0483 <br /> <br />AREA' 1.74 UNITE ~C MRSS, LOT yE~CO~N~R:NO <br /> <br /> MAP <br />AR 48 <br /> <br /> NA'rER. SUPPLY: PN <br /> TEST HOLES READY: <br />904.024? SiTE EVALUATION NUHI~ER: 2824,5 <br /> <br /> ~i~TiN~ D~/N FIELD LiNE~: <br /> SEPTIC T~K ~NPED: <br /> PREVi~S NOi BED~: <br /> <br />STANDARD ON-SITE SYSTEM <br /> <br />q.IJAN'F 1 'FY AIv~3JN'F <br /> 1 $210.00 <br /> <br /> TOTAL A,%~EDFEES $210.00 <br /> PREVIOUS RECE[PTS $0.00 <br /> THiS RECEIPT $210.00 <br /> <br /> BALANCE DUE $0.00 <br /> <br />PAYEE: HANK[NB , ROBER] J JR. RECEIPT NO: 42287 <br />RECEIVED BY~ CL .................................................................... TYPEt CK CHECK ~ 1007 <br /> <br />SEE ATTACHED orocu~",ll' POR REq~iREI~IENT~ OF ON-SiTE SEWAGE SY~JTE~+ <br /> <br />* TH[~ [5 NOT A PERNIIT. THIS APPLZCAT[ON lua.,'ST ~O THR~U~.,I A REVIEW PROCEE, S ~,-~ERE THE <br />FOLLONINEi r.4UST BE CQF4PLETED~ IT [~ THE RI~51;K31'~[B[LITY OF THE APPLICANT TO AS~URE THAT <br />ALL NECE~SARY INPORI~'t~TiON HA~BEEN PROVIDED. <br /> <br />OFFICE COPY <br /> <br /> <br />