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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 />hsve read and agree to the terms stated on the reverse side of <br /> document, <br /> <br />SIGNAfUI~E OF APPLICANT: <br /> <br /> DATE: <br /> <br /> DATE= 09/J.?/92f TIfqE" 16: 14: <br />OWNCR <br /> CO×-QUINTQN, PHILIP & t)F:BRA <br />SITUS ~OOHESS <br /> <br />902607 <br /> <br />6 iTEGORY <br /> <br /> RE!~If) ENTIAL <br />6 2CUPANCY <br /> <br /> 155 CLIFFORD AVE <br />DE'fRO I T <br /> <br />POR'¥'LANT), ~(,')R 97219 <br />PHONE= 245'" 64L~8 <br /> <br />IR 97~42 <br /> <br />DETROIT <br /> <br />SUBO ViSiON <br /> <br /> F'~TTON II <br /> <br /> SITE NUM~ER: <br /> VALUATION~ <br /> <br /> LOAD <br /> <br />NO OF 8EOR00MS <br /> <br />93-01527 <br /> <br />75 , 135 10:L25. SF Fig NO <br /> <br />TYPE: OW-SITE SEWAGE <br /> <br />PERMIT OR APPLICATIQN NO: <br /> <br />CONTF(ACTOR,~ NO. 44077 <br /> He~'~ry Alluim Excawting Ltd <br />48~ L. oar Rd <br /> <br />PHONE: 87S-4347 <br /> <br />WATER SUF'PLY: CW <br />TEST HDLE8 READY: <br />SITE EVALUATION NUMBER: 46816 <br />EXISTINg; TANK SIZE'-': <br />EXISTING DRAIN FIELD LINES: <br />sEI~'FIC TANK PUHF'ED: <br />PREVIOUS NO. ~EDROOH~: <br /> <br /> ITEM OUAN'rlTY AMOUNT <br /> STANDARD ON-SITE SYSTEM 1 $255.00 <br /> <br /> TOTAL ASSESSED FEES $255.00 <br /> PREVIOUS RECEIPTS $~,, <br /> TNIS RECEIPT $255. <br /> <br /> BALANCE gllE <br /> <br /> FAYEg: Nemy A].tuis Excavating Ltd INVOICE NO: 5248¢ <br /> RECEIVED BY: PH ........................................................ TYPE: IN CHECK $: <br /> <br /> SEE ATTACHED DOCUHENT FOR REQUIREHENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br /> * THIS IB HOT A PERMIT. TH~ APPLI~T~OH MUST CO THROUCH A REVIEW PROCESS ~HE~E THE <br />FOLLOW}]~G MUST BB COMPLETED. tT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />AL, L NESESSARY INFORMATION HAS BEEN PROVIdeD. <br /> <br />OFFICE COPY <br /> <br /> <br />