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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STF1EET NE <br /> SALEM, OREGON 97301 <br /> <br />;) <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am a registered t~uilder OR ( ) the authorized repfeser~tative <br />gf ~ ~egistered builder, <br />The work will be performed by a registered builder. <br />Other <br /> <br />this documem. <br /> <br />,'oWNGR:j j~ S'J'EWAt;~T J~II]H~ES T~X LeT <br /> <br /> 745~ 75'fH PLACE SE <br /> ~[]~W~M,,E OR 92325 ~¢~ ~NTY <br /> <br />USE OF IBUlt,[itN_~: ............... <br /> <br />VALUATION: <br /> <br /> OCCUPANCY: <br /> <br />id86UPANT LO^O: <br /> <br /> 26 <br />!WIDTH' OEP+N; .... AR~A: '' '~:[. Z8 <br /> <br /> TYPE: OW-SITE SEWAGE ~TER 8Oi,"~LY: PW <br /> J '[E~'r HOLESI READY: YES <br /> PERMIT OR ABPLICATIO~ NO: 528~4 ~'f'E EVAL~TIO~ I, LMBE :(: <br /> / J E~TIN(;~ANK SIZE. <br /> CONTRACTOR. NO. 8,58:;.~ q ~ ~.~[~AZN F'IEL.,9 LINES: <br /> A & ~ Sept:Et Service ]:m:: ~l[ SE~:~ TANK PUMPED: <br /> ~25 W:i.~dsor :Is Rd N ~EVIOUS 40. BEDROOMS: <br /> <br /> ITEM QOANTITY AMOUNT <br />SITE EVALIJAI'];ON~ FIRST LOT I $265.0/~ <br /> <br />TOTAL ASSESSED I--EES $265,.00 <br />PREVIOUS RECEIPTS <br />THIS RECEIRT <br /> <br />BALANCE DUE '~i), 0() <br /> <br />REOE:I'PT NO: <br /> <br />PAYEE <br /> <br />REC::]'VED ~,Y. cl TYF'E: CHECK 4~: 0 <br /> <br />SI:'.L.' ATI'ACHE~ DOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM.. <br /> <br /> NOTE: THIS DOE'S NO]' 6RANT OR IMPLY F'ERMISOION TO BUILD ON THIS PARCEl ..... F'LAI,II,IZNG ANT) <br />ONSTRI. fCT;I:ON I-%RM]:TS Htl~l'l BE OBTAINED BEFORE BUILDING OR SEPTIC ]:NS'Y'AI,J,,.AT]:ON BE,~.[F,,.h,-¢" ~ <br /> <br /> RIEMARKS:. t~E.~N.O~II,i6 FURTiiL::R EVALUATION OE ADDITIO4AL "r~T~'[TS. MI'EH-' 'O,8]~:':~ <br /> ...... RUI'(A[~;,;24-~4 NO ACTIVITY, ***EXPIRE APPL,.I~'~Z~)~**** ........ <br /> ¢)u,,1¢/1.~ E,. WO[~I~A~i~SN CSu~'rY ~UiL9I;4~ OFFICIAL / BY ................ ~ ................................................ <br /> <br /> OFFICE COPY <br />FORM ¢/~S 15-58 REV. 4/90 <br /> <br /> <br />