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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 />Other <br /> <br />SIGNATURE O¢ APPLICANT: <br /> <br /> DATE+. 05/26./92 <br />SITUS ADDREss;~,~E,i;,A · LOU <br /> <br />CONSTRUCTION TYRE: <br /> <br />' OCCUPANCY: <br /> OCCUPANT LOAD: <br /> <br />'FINE.+ 8:17t27 <br /> <br />MAP; <br /> <br /> 8973 SHAH SqUa6 R0 .... <br />:USE OAL~tCjg, t~E:LE OR 97325 <br /> <br />DrC~Ri ON COUNTY NO <br />SUBDIVISION: <br /> <br />SECTION: TOWNSHIP: "A~E~ NUIv~3ER'r'~Tet 9;"2 <br /> VALUAT I ON ~ ' <br /> <br />~AILI~G ADDRESS: ~ ~. ~ <br /> <br /> 9003 SHAH ,,S~UARE RD SE <br /> AU~SV ! LLE <br /> \- <br /> <br />:LOT: PHONE: <br /> <br />24 : 8S , 2H AR3 <br /> <br />RESI DENT IAI <br /> <br />NO DF BBDROOMS: <br /> <br />4 <br /> <br />51 <br /> <br />1, AC NO NO <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERNII' OR APPLiCATiON NO: 39583 <br /> <br />CONTRAC'rOR~ NO. <br />ME:LA. LOU <br />9003 S-lAN SQtJARE RD SE <br />AUMSVILLE <br />PBONE: ?49-1011 <br /> <br />HATER f~4JPPLY: PH <br />TES'r HOLE~ READy: <br />SiTE EVALUA'FION NUMBER: <br />· E.';';';';';';';';'~4iS'¥iNG T,~CWK ~IZE: I000 <br />E2(JSl'iN8 DRAIN FIELD LINES: <br />SEPTIC T/~NK PUMPED: <br />PREVIOUS NO. BEDRO~: <br /> <br /> I TEJVl qUANT I TY ~N'F <br />EXIS'flNG SYSTEM EVAL. RPI', 1 $130.00 <br /> <br />'FOTAL .ASSE.,~SEDEEE~ <br />PREVIOUS RECEIPTS <br />THiS RECEIPT <br /> <br />~l~O.O0 <br /> $o.o0 <br /> <br />BALANCE CUE $0.00 <br /> <br />PAYEE: RECEIP'f'NO: <br /> <br /> RECEIVED BY: pb2 TYPE: CHECK ~;: 0 <br /> <br /> SEE AI"I'AC~ED DOCUMENT FOR RE(~JiRElSlENTS O~ ON-SITE SEWAGE SYSTSM, <br />x~ THIS iS A VALID PEI~IIT :~ THIS PERi,liT EXPIRES 360 DAY~ FROM ITS ISE~JE DATE. IF <br />CONSTRUCTION FAIL~ TO MEET ALL I~L=(~JIRE~TS ~ '~TATE LA~ ~D ~RioN COUNTY BUILOIN(~ AND <br />ZONING ORDINANCES, THI~ PERi, IT SHALL t~ECC~lE NULL AND VOID. <br /> <br /> REI'4ARKS,: EX,.i,S'I'ING SYSTEM EVAL FOR PARTITIONING EXISTING SYS'I'EIV~ <br /> ....... ,~BS'FANDARO 'rD CURRENT RULE~. SE,E, RE¥I~,'EO PLOT PLAN DA'rED 5-22-92 ~'~ ~\ <br /> 0ONALD~E. NOODLEY, '~'¢ARiON COUNTY BUILDING OFFICIAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC 15,56 REV. <br /> <br /> <br />