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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 />am a registered buitder OR ( ) t~e autf~orized representetive <br />a registered Duilder, <br /> <br />DATE: 09/08/92 TIME: 8:14:16 <br />ROSE, FRANKLIN <br /> <br /> 11;544 J~HES <br /> AUMSVILLE OR <br /> <br />RESIDENTIAL <br /> <br />LOT: <br /> <br />521o RIVER ROAD N ~1000 i <br />KEIZER 9730:3 OFFICE 593-5624 X-$50 r SITE NUNI~ER: 92-05199 <br />PHONE: 590-9555 i VALUATION: <br /> <br /> i Bt_O~K: I TOWNSHIPz RANGE: i ZOh~: , MA~ <br /> m 29 , 8S , iW ~ AR 48 <br /> <br />TYPE: ON-SITE SEWAGE <br />PERHIT OR APPLICATION NO: 9042400 <br /> <br />CONTRACTOR, NO. <br />ROSE, FRANKLIN <br />5210 R~VER ROAD N ~1000 <br />KEIZER 97~03 OFFICE 393-3624 X- <br />PHONE: ~90-935~ <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUHBER: 28245 <br />EXISTING TANK SIZE; <br />EXISTING DRAIN FIELO LINES: <br />SEPTIC TANK PUMPED: <br />pREVIOUS NO. 8EDROOHS: <br /> <br /> ITEM QUANTITY AHOUNT <br /> STANDARD ON-SITE SYSTEM I $210,00 <br /> <br /> TOTAL ASSESSEDFEE8 $210.00 <br /> $0.oo <br /> <br /> , $o.oo <br /> PAYEE: ROSE, FRANKLIN RECEIPT NO. 44465 <br /> RECEI~EO BY:.~M2 ~ L~ ~ . TYPE- CE CHECK ~- 1006 <br /> <br /> SEE ATTACHED DOCUMENT;FOR REQU.!REMENTS'OF ON~S~E SEWAGE SYSTEM. <br /> <br />* TNI8 ~$ NOT A PERHIT., A EEVIE# PROCESS WHERE THE <br />FOLLOWING MUST BE COMPL:ETED. IT I$ THE :RESpON$~BI:LITY:OF THE APPLICANT TO ASSURE TR~T <br />ALL NECESSARY INFORMATION HAS 8EEN. PROVIOEO.: <br /> <br />PLAN REVIEW: BY ...... JATE_ _ CITY JURISDICTION: BY ......... DATE <br /> <br /> <br />