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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STREET NE <br /> EALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />l am a registered builder OR ( ) the authorized representative <br />of a registered builder, <br />The work will be performed by a registered builder, <br /> <br />r~VNER DATE: 02/1,7/94 TI~E: 9:36:16. . <br />(' ' .... FAX LOT' ................ i~CATEGORY: <br />~ HUBBERD, TIM 90148-041 I RESIDENTIAL <br /> <br /> 14747 ALBERS WAY NE -~'6~f~A~ C,~Y.' ........ <br />. AURORA OR 97002 AURORA NO <br /> <br />8995 SW PINEBROOK ......... ~R'S"CR~--~D~ ................. <br />TI~ARD, OR 97224 SITE NUMBER: 94-00697 <br />PHONE: 639-6890 VALUATION: <br /> <br />..... 5 I i 12 48 IW .; R-1 ...... <br /> 23102. SF YES NO <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERNIT OR APPLICATION NO: 9052970 <br /> <br />CONTRACTOR, NO. 33830 <br />DENNIS GIBBIONS-PRICE RITE SEPT <br />18220 NE HILLSIDE DR NEWEERT. <br />NEWBERG, 97132 <br />PHONE: 538-2276 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: ALBERS ADD <br />EXISTIN~ TANK SIZE: <br />~XISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br />STANDARD ON-SITE SYSTE~ QUANTITY AMOUNT <br /> <br /> TOTAL ASSESSED FEES <br /> PREVIOUS RECEIPTS <br /> THIS RECEIPT <br /> <br /> BALANCE DUE <br />PAYEE: DENNIS GIBBIONS-PRICE RITE sEPTiCS <br />RECEI.VED BY: CL <br /> <br />INVOICE NO: <br />TYPE: IN <br /> <br />1 $255.00 <br /> <br /> $255.00 <br /> $o.oo <br /> $25s.oo <br /> <br /> $0.00 <br /> <br /> 55430 <br />CHECK #: 0 <br /> <br />SEE ATTACHED DOCUMENT FOE REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. " ..... <br />* TNIS IS NOT A PEP, HIT. THiE APPLICATIO~ ~ST GO TMROUGH A REVIE~ P~OCESS WHERE THE <br />FOLLOWING MUST BE COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORNATION MAS BEE~ PROVIDED. <br /> <br />PLAN REVIEW: BY <br />REMARKS: PERMIT <br /> <br />DATE <br /> <br />CITY JURISDICTION: BY <br /> <br />DATE <br /> <br />~O.M ¢ ~C ~-.~.~V. 4/~ OF FlOE COPY <br /> <br /> <br />