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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 o 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />Other <br /> <br /> ;¢hI',IT;E AN <br /> <br /> 11373 HILL CREEK <br /> AI.JNSVZ LLE <br /> <br />SANE <br /> <br />PHONE: 769--7744 <br /> <br />,w'iDTHi DEPTH: <br /> <br />TAX LOT: <br /> 56450900 <br />CONSTRUCTION TYPE: <br /> <br />DATE; <br /> <br /> --' ' CONTRACT CITY: UGB; <br />OR 97;;~25 ' NAR]]-)N C:OUNTY: <br /> <br /> Cf}HHEJ:~CI AL <br />: OCCUPANCY: <br /> <br /> ;L 5 <br /> <br />STTE NUMBER: 94-~1217 <br />VALUAT]:ON: <br /> <br />SE~TION; toWNSHIPl RANGE: ZONE: <br />32 8S :I.W <br />AREA'. UNITS; IRREG. LOT: CORNER: <br /> <br />MAP: <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PEEI~iT DR RPPL1CATTDN NO.' 9853817 <br /> <br />CON'FRACTOR~ NO. <br />',]ANTIAM NO~:[LE HOblES . I~ [, <br /> <br />WATI':'R SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER:~ <br />EXISTING TANK <br />EXTS'I'IN(; DRAIN FIELD I. TNES: <br />SEPTIC TANK PUMPED"- WILl,,, <br />PREVIOUS NO,, t:~E;OROONO~ 7 <br /> <br /> :[TEN QUAI,ITITY AtdOONT <br /> AIJTHORIZAT~ON NO'F:[CI"" - FIEL~ vlsz'r 1 ,',1 I,~ <br /> <br /> TOTAL ASSESSE9 FEES $169.90 <br /> THIS REgE~P~ ~1~¢, <br /> BAL;ANCE DUE $~ <br /> <br /> PAYEI~¢: SANTIAH HO~II_E NONES RECc, IFI NO: 56288 <br /> RECEIW'.~ BY., CL._ .................................................. ~__~..,, ......... TYFL. CK CHEI,,K ~: 84~8 <br /> <br /> SEE; ATTACHE'I) ~OCU~ENT FQR REQUIREMEN'rS QF ON-tSI'rE SEWAGE SYSTEM. <br /> <br /> ~ THZ~ IS NOT A PERMIT; THIS APPLICATION HUST ~O THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING ~UST ~E COHPLETED= ZT ZS THE EESPOHS;[BZLZTY OF THE ~PPL2C~HT TO ~SSURF; TH&T <br />ALL NECE,,,,SARY INF:'ORNATION HAS BEEN PROVidED, <br /> <br />PI_AN k,;V;~ I:! ), ItY,. I)A'TE .... = <br />RENARI(S: <br /> <br />FORM ~ MC 15,56 R~%/, 4/90 <br /> <br />CITY JURISDICTION: BY ................. DATE ............................ <br /> <br />OFFICE COPY <br /> <br /> <br />