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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STREI=T NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PRONE: 588-7904 <br /> <br />lam performing work orl a proDerty f own or occupy. SIGNATURE OFAPPLICANT~ ~~-~. <br />lart~aregisteredbullderOR( )theautho¢izod representative <br />of a registered builder, <br />The work will De performed by a registered builder. <br />Other_ <br />I have read and agree to the terms stated on the reverse side of DATE: <br />this document. <br /> <br /> DATE: 01/09/82 TIME: 11:54 27 <br />OWNER: <br /> FOREMAN, 'fHERESA <br />SI~US ADDRESS: <br /> <br />TAX LOT: I CATEGORY: <br />CONSI'Ru~TION TYEE: OCCUPANCY: <br /> <br />RESiDENI'IAL <br /> <br />CONTRA~T CITY: i SGB; <br /> <br /> 562 11TH S'r N <br /> AUMSVi LLE OR 97325 <br /> ....................... ;ffiAR.[ON .COUNTY. i NQ <br />USE OF BUILDING: <br /> <br /> 5At4E <br /> PHONE+* 74.9-1503 <br />LOT: ;BLOCK: <br /> <br /> SITE NUMBER: 92-00283 <br /> VALUAT I ON: <br /> SECTION: : TOWNSHIP: RANGE: zoNE~ MAP: <br /> <br /> ! i 25 8~ AR <br /> IDEPTH; : AREA; UNITS; , IRREG. LOT: ; CORNER'. <br />271! 380 102980 . ~F NO i NO <br /> <br />'fYPE: ON-SiTE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CON'FRAC'rOR, NO, <br />FORPJ~IAN, TH ERP.,.%A <br />SAME <br /> <br />PHONE: 749~1503 <br /> <br />9037874 <br /> <br />~TER ~PPLYt ~ <br />T~T HOL~ R~DY; ~' <br />SiTE EVA~A1'[~ NU~ER= <br />~ISTIN6 'F~K SIZE: ~ <br />~iSTiNG D~iN FIELD LINE$~ / <br />SEPTIC '[~K ~MPED: WIgL I),~/~'L IN <br /> <br /> i I'EJ~I <br />ANNUAL EYAL. - 'I'FJ~P OR HDSHP IVlH <br /> <br />PAYEE: FOREMAN, THERESA <br /> <br />I'OI'AL ~S~ED FEES <br />PREVIOUS REW3Ei PTS <br />THiS RECEIPT <br /> <br />~LIAN T I T Y AffDUNI' <br /> 1 $80.00 <br /> <br />$60.00 <br /> $o.oo <br /> <br />BALANCEE~JE <br /> <br /> RECEIPT NO: 39850 <br /> <br /> RECEIVED ElY: CL ..................................... ..;; ............ 'TYPE: CK CHECK ~: 2638 <br /> <br /> SEE ATTACHED DOCUMF..~T FOR REQUtRE~P.N'rS OF ON-SiTE <br /> <br />* THIS IS NOT A PE~IT. THi8 APPLI~TI~ ~T '~ TH~ A R~I~ P~ ~E THE <br />~L~IN~ ~ST BE ~PLETED+ IT 15 THE R~:IB/LiTYOE THE APPLI~T TO ~R~ THAT <br />ALL N~RY /N~TI~ H~ <br /> <br />REMARKS: TOTAL OF z~/BO'i'H RES <br /> <br />CITY JURISDICTION: BY DATE <br /> <br /> OFFICE COPY <br />PeRM # MC 15.56 REV. 4/90 <br /> <br /> <br />