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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 /> <br /> I ~lm a reD~stered builder QR the authorized repreReotative S~GNATURE 0¢ ARBL CANT. ~ <br /> ~ am performing work on a property I own or occupy, o <br /> <br /> of a registered buildor, <br /> The work wil~ be perfarmed by a registered builder, <br /> Other <br /> I have read and agree to the terms stated on the re,~erse side o¢ DA'F~' <br /> <br /> DATE: 07/09,/92 TIME: 16:16:58 <br />OWNER: TAX LOT <br /> HILLIGOS$ <br /> <br /> CONSTRUCTION YYPE: OCCUPANCY: <br /> <br />SITUS ADDRESS: <br /> <br />CATEGORY: <br /> RESIDENTIAL <br /> <br /> il~6i STEINKAMP RD SE <br />AUNSVILLE OR ~732S ~lc~ci~c~:UNTY ~J~ <br /> <br />USE 0¢ BUILDING; <br /> <br />MAILIN~ AbSMES~'. <br /> <br />PHONE; <br /> <br />0ITTER MILL <br /> <br /> SITE NUHGER: <br /> VALUATION: <br /> <br />92-02555 <br /> <br />NO OF 8~ORO0~S <br /> S <br /> <br />ii 28 88 48 <br /> S. 02 u NIT~;c <br /> <br />RANGE 7. ONE <br />ZW AR <br />MO NO <br /> <br />TYPE: 0N-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />HILLIGOSS <br /> <br />PHONE: <br /> <br />9041165 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: 85-661 <br />EXiSTiNG TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEOROOMS: <br /> <br /> ITEM QUANTITY AMOUNT <br />STANOARO ON-SITE SYSTEM 1 $210.00 <br /> <br />PAYEE: HILLIGOSS <br /> <br />TOTAL ASSESSEO FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$210.00 <br />$o.oo <br />$21o.oo <br /> <br />BALANCE DUE $0.00 <br /> <br />RECEIPT NO: <br /> <br /> 43206 <br /> RECEIVED BY: CL TYPE: OK CHECK $: 6481 <br /> SEE ATTACHEO OOOUMENT 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 MUST 8E COMPLETEO. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORHATION HAS BEEN PROViOEO, <br /> <br />REMARKS: PERMIT <br /> <br />CITY JURISDICTION: 8Y .............. DATE ......................... <br /> <br /> OFFIOECOPY <br />FORM # MC 15-56 REV, 4/90 <br /> <br /> <br />