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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG, NO, <br /> 220 HIGH STREI=T NE <br /> SALEM, O. REGON 97301 <br /> <br /> PHONE:588-5147' 8:00- 4:30 <br />24 HOUR CODE-A-PHONE: B88-7904 <br /> <br />I am performing work on a property I own Or' O¢OVpy, <br />I am a registered builder OR ) the aufhorized representative <br /> of a registered~ builder. , <br />The w(~rk wilJ be performed by a registered budder. <br />Other_ <br /> <br />OATE~ 09/03/92 TIHE: 9:57:49 <br />COX-QUINTON, PHILIP & DESRA <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE~ <br /> <br /> CONSTRUCTION TYPEI <br /> <br />CATEGORY: <br /> RESIDENTIAL <br /> <br /> 165 CLIFFORD AVE -- <br />DETROIT OR 97342 <br /> <br />OCCUPANT LOAD: <br /> <br />MA~L. ING ADDRESS: <br /> <br /> S746 SW COMUS <br /> PORTLAND, OR 97219 <br /> PHONE: 245-6458 <br /> <br />PATTON [I <br /> <br /> SITE NUHBE~: <br /> VALUATION: <br /> <br />92-00450 <br /> <br />LOT: BLOCK: SECTION: <br /> 6 6 1 <br /> <br /> AREA: <br />WIDTH: 75 OEP)H: 1~S <br /> <br />1012S. <br /> <br />20 5E RS <br />U NIT~ F~G LO1 OO~£= <br /> <br />MAP: <br /> <br />TYPE: OW-SITE SEWAGE <br /> <br />~ERNIT OR APPLICATION NO: <br />OONTRACTOR~ NO. <br />COX-QUINTON, PHILIP & OEBRA <br />~746 8W COMUS <br />PORTLAND, OR 97219 <br />PHONE2 245-64~8 <br /> <br />42049 <br /> <br />WATER SUPPLY: CH <br />TEST HOLES REAOY: YES <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTIN~ DRAIN FIELD LINES: <br />SEPTIC TANK PUMPEO: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM <br />SITE EVALUATION~ FIRST LOT <br /> <br />TOTAL ASSESSEO FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY AMOUNT <br /> 1 $220.00 <br /> <br />$220.00 <br />$Z20.00 <br /> $0.00 <br /> <br />BALANCE DUE $0.00 <br /> <br /> INVOICE NO: <br />TYPE: CHECK ~: 0 <br /> <br />PAYEE: <br />RECEIVED BY: cl <br /> <br />SEE ATTACHED DOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br />NOTE: THIS DOES NOT GRANT OR IMPLY PERMISSION TO GUILD ON THIS PARCEL. PLANNING AND <br />ONSTRUCTION PERMITS MUST BE OBTAINED BEFORE BUILOING OR SEPTIC INSTALLATION BEGINS. <br /> <br />REMARKS: SE denied / stake out required for revaluation <br /> <br />DONALD E. WOODLEY, MARION COUNTY BUILDING OFFICIAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC 15 56 REV, 4/90 <br /> <br /> <br />