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MARION COUNTY BUILDING INSPECTION
<br />· , SENATOR BLDG. NO, 225
<br /> 220 HIGH STREET NE
<br /> SALEM, OREGON 97301
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<br /> PHONE: 588-5147 8:00 - 4:30
<br />24 HOUR CODE-A-PHONE: 588-7904
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<br />of a registered builder,
<br />The work wiil be pedormed by a registered builder·
<br />Other
<br />
<br />this document.
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<br />SIGNATURE OF APPL CANT
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<br /> }:',OTFCI:[:K,,, £:,AI:'W t i 67009'-'002 i RES:~bENTIAL,
<br />~i¥~J§ ,i, bJ'dR~$'$1 I CONSTRUCTION TYPE: ,: OCCUPANCY:
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<br /> 2C~8 H]:LL S'F __ f CONTRACT CITY: UGB; ¢OCOUPANT LOAO:
<br /> 9ETROIT OR 97;~42 ~, 9ETROZT [ NO I
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<br /> 7~3'3 BECEL..[9 PL. '~17
<br /> rHONE= 8 J. 8---~88-51! I 1 ' VAI. UATIOH:
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<br /> 155
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<br />TYPE: ON-SITE SEgACE
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<br />PEENIT OR APPLICATION NO: ?~55§21
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<br />CI]I'~TRACTI/I:~, N,q.
<br />KEVII,P S fJACKHOI::
<br />PO BOX 465
<br />?.,ETROIT.
<br />F HONE,- 854--~797
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<br />WATER SUPPLY: CW
<br />TEST HOLES READY: W/CALL
<br />$II'F EVALUATION
<br />EXISTING TANK SIZF:
<br />EX]'STJ'I,.IG DRAIN ISIELD LINES:
<br />SEPTIC TANK PUNPED:
<br />PRE¥IOUS NO. BEBROOMS:
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<br /> I'I'EH QUAI,ITITY AHOUN'?'
<br />Sill'_". EVALLIATION,¢ FEIiRST LOT I ,I .¢.6,_
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<br /> tOTAl_ ASSESGEg ,FEE,~ ¢285,,
<br /> PEE~IOL S RECE IF TS $~.
<br /> ' TIIIS RECEIPT ¢265.
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<br /> BALANCE, DUE $~.
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<br />PAYEE: K~ZV:[I,P8 BA;(tfE INVOICE NO: 57?98
<br />RF~LCEIVE,:D BY~ F'~ TYF'E:~ :I:N CH[:L~'" ,u.l, ~
<br />SEE ATTACHE~ D(]CUf'IEI,I~ FOR RE(]UIRE~EI~T8 OF' ON-SITE SEWAGE SYSTEH~
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<br />NOTE: TI,Ii., DFIF'S NOT GRAP,? OR IMPLY PERHISSION l'O BUILD ON THIS PARCr;I .......
<br />OH, TM,lC 1011 _Rtd.l,r,, Nus'r ;~1~ O~TATltED BEFORE BUILDING OR SEPTIC ZNS'FALLAT];ON
<br />Pt,hN RtW:rF~:, BY,.~, ~ATE_~/~¢_. C]"tY JtJRZSOZC'rZON: ~Y ......................... DA'f% .....................
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<br />FO~ # MC ~s.~ R~V, 4/t~ OF: FICE COPY
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