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MARION COUNTY BUILDING INSPECTION <br /> SER4ATO¢~ 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 a registered buitder OR ( ) the authorizod representative SIGNATURE OF APPLI <br /> <br /> ORTE; 08/24/92 TIMEr <br /> OWNER'. TAX LE)~i ' CATEGORY: <br /> LIFFLANOER, ,IOHN & CAROL 57665-000 , RESIDENTIAL <br /> SITUS ACDRSSS: coNSTRUb~IPN ~'~¢~i 'dOcuPANC¥: <br /> <br /> 8851 8MITN RB <br /> AUNBVILLE <br /> <br />USE OF BUILDING: <br /> <br />OR <br /> <br /> SE ' CONTRACT CITY: UGB: OCCUPANT LOAD: <br />97325 .MARION COUNTY NO <br /> <br />LOT: <br /> <br />3290 BALSAM DR S <br />SALEM OR 97302 WK 378-37~8 SITE NUMBER: 92-01640 <br />PHONE: 363-6418 VRLUATION: <br /> <br /> BLOCK: SECTION: TOWNSHIP; RANGE: : ZONE: MAP: <br /> 2¢ 88 2W SA 51., <br /> 31.4 AC NO : NO <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: 9042118 <br /> <br />CONTRACTOR, NO,, <br />L, IFF'LANDER. JOHN & CAROL <br />3290 BALSAM DR S <br />SALEM OR 97502 WK 378-~738 <br />PNONE: 563~64~8 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: 39804 <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEOROOHS: <br /> <br /> ITEM @UANTITY ANODNT <br /> STANDARD ON-SITE SYSTEM i $210,,00 <br /> <br /> TOTAL ASSESSED FEES $210.00 <br /> PREVIOUS RECEIPTS $0,,00 <br /> THIS RECEIPT $210,,00 <br /> <br /> BALANCE DUE $0.00 <br /> <br /> PAYEE: LIFFLANBER~ ~OHN & CAROL RECEIPT NO: 44164 <br /> RECEIVED BY: CL ........................................ TYPE: CK CHECK ~: <br /> <br /> SEE ATTACNEO DOCUMENT FOR REQUIREMENTS OF ON-'SITE SEWAGE SYSTEM. <br /> <br />* THIS IS NOT A PERMIT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING HURT BE COMPLETBD~ IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAI' <br />ALL NECESSARY INFORMATION HAS BEEN PROVIDED. <br /> <br />REMARKS: PERMIT <br /> <br />CITY JURISDICTION: BY ........ DATE .................. <br /> <br /> OFFICE COPY <br />FORM # MC 15-5¢~ R~V, 4/90 <br /> <br /> <br />