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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STREET NE <br /> SALEM, ORBGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />of a re§istered builder, <br />Hie work will be performed by a registered bu4{def. <br />Other , <br /> <br /> DA'[E: 91/16/92 rifflE: <br />OWNER: <br /> FOREt4AN , I'H ERP.~A <br />$tTUS ADDRESS: <br /> <br />TAX LOT <br /> <br />OONSTRUCTION TYPE <br /> <br /> 582 ll'[H ST <br />AUtc~ViLLE OR 9?325 <br /> <br /> CONTRACT CITY UGB <br />_. FL&RiON C01JN'~Y NO <br /> <br />PHONE: 749-1503 <br /> <br /> . 25 .......... <br /> 271' 380 102980 <br /> <br /> SITE NUMBER: 92-0028:¢ <br /> VALUA'r i ON: <br />RANGE ZONE <br /> <br /> ....... 2~. ...... AR <br /> NO NO <br /> <br />CATEGORY <br /> <br />OCCUPANCY <br /> <br />OCCUPANT b,OAD <br /> <br />RES i DEN TI A[ <br /> <br />MAP <br /> <br />TYPE: ON-SiTE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO+ <br />FOREN1AN, 'FHER~A <br /> <br />~E: 749-1503 <br /> <br />37874 <br /> <br />WATER ,~AJPPLY: PN <br />TNT HOLES READY+~ <br />SITE EYALUATiON NUF~BER: <br />~IST[NG 'r~K SIZE: <br />~iSTiNG D~iN FIELD LINES: <br />SEPTIC 'r~K ~MPED: 12-16~91 <br /> <br /> i 'fP34 QuAN'f I I'Y AMOUN'f <br />ANNUAL E%'AL. - TEMP OR HL~HP ~ 1 $60.00 <br /> <br /> TOTAL A~ED FEF-~..5 $60.00 <br /> PREViOJS RECEIPTS $60.00 <br /> ]'HIS RECEI P? $0.00 <br /> <br />PAYEE: <br />RECEIVED BY: C] <br /> <br />BALANCE f.~E $0.00 <br /> <br />RECEIPT NO: <br />CHECK <br /> <br /> TYPE: 0 <br /> SEEATTACHED DOCUMENT FOR REQ~JIR~M~TS :OF ~-SITE SEW~E S~T~. <br /> <br />~ THIS IS A VALID PE~IT ~ THIS PE~IT i~I~ 360 ~ F~ ITS [~E ~TE. IF <br />~8T~CTI~ FA[~ TO M~ ALL <br />Z~iNG ORDiN~C~, THiS ~[T ~ALE: B~E NUL~ <br /> <br />REMARKS: TOTAL OF 4/8OTH RE~ <br /> <br />0ONALD E. ~'¢OOOLEY, MARION CO~N'I'Y BUiLDiNG OFFiCiAL / BY ................................................................................... <br /> <br /> OFFICE COPY <br />FORM # MC 1~-~6 REV. <br /> <br /> <br />