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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 /> I am performln9 work on a property I own or occupy, <br /> I am aregisteredbuiJderOR( } the authorized representative <br /> of a registered bu{Ider, <br /> The work wild be pedormed by a registered builder. <br /> Other. <br /> I have read and agree to the terms stated on the reverse side o¢ <br /> <br /> DATE; 06,/24/92 TINE.* 6: 34 *.28 <br />OWNER: TAX <br /> EMERY, ADRIAN C, JR. & J/~qEf E. <br /> <br />SITUS ADDRESS: <br /> <br /> CATEGORY; <br />90250-020 <br /> <br /> OCCUPANCY: <br /> <br />CONSTRUCTION TYPE: <br /> <br />130 LAKECRE~T OR <br />DE'f 'ROi T <br /> <br />OR 9?342 <br /> <br />CONTRACT CITY: UGS: OCCUPANT LOAD: <br />; DETROIT NO <br /> <br />MAILING ADDRESS; <br /> <br />PO BOX 439 <br />AUMSVILLE OR 9?325 <br />PHONE: 749-2624 <br /> <br />SUBDIVISION; <br /> PATTON A B r..) <br /> <br /> SITE NUMBER: 92-01760 <br /> VALUAT i ON: <br />SECTION: : TOWnShIP: RA~E: ' SONE~ <br /> 01 10 5E , RCS <br />AREA: 16376. UNITS; SF rRRSG, LOT: NO CORNERNo <br /> <br />RES 1 DEN'Y' 1 Al <br /> <br />MAP: <br /> <br />TYPE: ON-SiTE SEWAGE <br /> <br />PERNi'f' OR APPLICA'[ION NO: ,~9841 <br /> <br />r..%.IN'FRACTOR, NO, <br />EMERY, ADRIAN C. JR. ~ JANET <br />PO SOX 439 <br />AUtASVILLE OR 9?325 <br />PHONE: 749-2624 <br /> <br />WATER SUPPLY: ~ <br />TEs'r HOLE~ RP_.;ADY; <br />SITE [:A/ALUA'FION NUi',IBER: <br />EXISTING TANK SIZE: 1000 <br />E.~ISTING DRAIN FIELD LINES.* <br />SEPTIC TANK PUMPED: 08/09/91 <br />PRE¥IOUS NO. 8EDRO~: <br /> <br /> I l'El',l QUAN'I' l TY AI~OUN T <br /> AU'FHORJ'.ZA'f'i:ON NOTICE - FLD. VISIT 1 <br /> <br /> TO'f AL ASSESSED FEES $130.00 <br /> PREA/i CUS RECEIPTS $130,00 <br /> THiS RECEIPT $0.00 <br /> <br /> BAL-/~,ICE DUE $0.00 <br /> PAYEE-+ iNVOICE NO: <br /> RECEIVED BY: P~ ................................. TYPE: CHECK ~; 0 <br /> <br /> SEE ATTACHED OOCUNEN'I' FOR REQUiREMP.~i'rs OF ON-SiTE SEWAGE SYSTB',I. <br /> <br />* THIS iS A VAL][D PERFIIT :* THIS PEI~iT EXPIRII~ 380 DAYS FRO~I ITS IS,.~E DALE. IF <br />O3NSTRUC:TiON FAII...~ TO rAEET ALJL. RE(~,.IIRBBTS OF STATE ~ AND I'~.RiON COJNf¥ BUILDING AND <br />ZONING ORDINANCES, THIS PERNIT .,SHALL BECOME NULL AND VOID. <br /> <br />RFJVlARKS: AUTH SEE RE~/ISED PLOT PLAN DATED 5-12-92 <br /> <br />DONALD E. WOODLEY, r. AARION COUNTY BUiLDiNG OFFICIAL / 8Y <br /> <br />OFFICE COPY <br /> <br /> <br />