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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BEDG. NO. 225 <br /> 22~ 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 />t am performing work on a property I own or occugy. <br />lamaregisteredbullderOR( } the authorized representative <br />of a registered builder, <br />The work Will be performed by a roglstered builder, <br />Other· <br /> <br />this document, <br /> <br /> DA'fE: O5/2O/S2, <br />OWNER: <br /> LEA, HARVEY <br />SITUSA~ORE~: <br /> <br />'"I~E; ]5:23:55 <br /> TAX LOT; CATEGORY: <br /> <br />CONSTRUCTION TYPE: OCCUPANCY: <br /> <br />RESIOEN/IAi <br /> <br /> 10253 MiLL CREEK ROAD SE i'0~; :08OU~AN~LdAD: <br /> AUMSV.£LLE OR 9'7325 <br /> i~)ARiON COUNTY, NO <br />USE OF BUiLDInG; ~0; 0F ~EDR00~S: ' <br /> <br />MAILING ADDRESS: SUBDIVISION; <br /> <br />PHONE: <br /> <br /> ~i'fE Nt,JI'4BER: 92-01922 VALUAT ION: <br /> <br /> 31 8S 1W : RA, 48 <br />197 352 SF' : YES NO <br /> <br />TYPE: ON-SiTE SEWAGE <br /> <br />PERMIT OR APPLICATiCN NO: <br /> <br />CONTRACTOR, NO. <br />LEA, HARVEY <br /> <br />9040108 <br /> <br />NAr'ER SUPPLY: N <br />'f'ES'F HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXJ~'f'2NG 'TANK SIZE: <br />EXISTING DRAIN FIELD LiNE~: <br />SEPTIC 'rANK PtJ~PE0: <br /> <br /> I'fEM QUAN'T'ITY AlvtOUNf' <br /> Au'r'MORiZATiON NOTICE - FLD+ VISIT ,~/)// ~ $130.00 <br /> <br /> $o.00 <br /> " THIS RECEIPT <br /> $~so.o9 <br /> BALANCE OUE <br /> <br /> PAYEE: ~ & M O~NS'fRUC'F'iON RECEIPI' NO: 42159 <br /> RECEIVED BY: D¢42 ................................................................................................................. TYPE: CK O~ECK ~: 2542 <br /> <br /> SEE ATIACHEO DOCUMENT FOR REC~JIREMEN'f'S OF ON-SiTE SENAGE <br /> <br />* THiS iS NOT A PERf41T. THiS APPLICATION I~$T 60 THROU(~H A RES/IEN PROCE,~..$ 9,~IERE THE <br />FOLLE~IN6 IvLIST BE CO~lrLETED. iT iS THE RESPONSiBiLiTY OF THE A~PLICAC4T TO A.~RE THAT <br />ALL NIECE:~;~ARY iNFORf~IATiON RA,~ BEEN PROviDeD. <br /> <br />DATE <br /> <br />FORM # MC I 5,66 RE~, 4/~0 OFFICE COPY <br /> <br /> <br />