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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLOC. NO. P25 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 /"x ~ ~ <br /> 24 HOUR CODE-A-PHONE: 588-7904 ( \ /-.-'~/_~,"'-h~ ~ ~ <br /> <br />IBm performing work on a property l own orocOupy, ~] J,,~.1~/4,./~'.~ 1~ ~ ~ ~ <br />t sm a rog Dieted builder OR ) the au horized represen ative SIGNATURE OF APPLICANT: ~.,,~_ v . (~W~"~"~ · /~' ~ ~ <br />of a registered builder, . ~ ......... r ~ <br />The work will be per[ormed by a registered builder, <br />Other <br />I have reed and agree to the terms stated on the reverse side ~of DATE: .................... <br />this document, <br /> <br />..... J ,IR S_T.6.W ~F(..T, -ONES i i RESIJDENTIAL <br /> <br /> 7450 75TH PLACE SE <br /> AUHSVILLE OR ~7~25 IHAEION COUNTY ! NO ' <br /> <br /> 68~ GARL~I,I9 CT N <br /> KEIZER,, OR BT~ ~ SITE HUHBER: 94-~624 <br /> PHONE: ~98-t1~8 ~ VALUATION: <br /> <br />TYPE: ON-SITE SEWAGE <br />PERHZT OR 'APPLICATION <br />CONTRACTOI% MO= 8581~ <br /> A & B Septic Service [nc <br />7~25 Windsor Is Rd N <br />Sa].e~ 9730~-0000 <br />PHONE: <br /> <br />9052854 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY= YES <br />SITE EVALUATION NUMBER: <br />EXISTING 'TANK SIZE: <br />EXISTING BRAIN FIEL~ LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO'. BEDROOMS: <br /> <br /> ITEM <br />~ITE EVALUATION, FIRST LOT <br /> <br />TOTAL ASSE$SE~ FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE 9UR <br /> <br />QUANTITY AMOUNT <br /> 1 $265.00 <br /> <br />$265.00 <br /> $0.00 <br />$265.,~ <br /> <br />$0.00 <br /> <br />PAYEE:,~., ^ ' D'-S~ ,: ........... RECEIPT NO: 55312 <br />RECEIVED BY: p~ ........... TYPE: CK CNECK ~: 2609 <br /> <br />SEE ATTACHE9 DOCUMENT FOR REQUIREMENTS ,OF ON-SITE SEWAGE SYSTEM. <br /> <br />NOTE.~ THIS DOES NOT GRANT OR IMPLY PERNZ,BSION TO BUILD ON TNIS PARCEL. F'LANM:[NG AND <br />ONSTRIJCTION PERMITS MUST BE OBTAINED BEFORE BUILDING OR SEPTIC INSTALLATION BEGINS. <br /> <br /> PLAN REVIEW: BY ................... DATE .................... CITY JURISDICTION: BY ................. DATE ...................... <br /> REMARKS: SE TH:READY <br /> <br />~o.M ~ uc t;~-~ ~EV, 4~ OF FICE COPY <br /> <br /> <br />