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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE:588-5147 8:00: 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />~ am a registered builder OR ( ) the ~uthorized represenlal~ve <br />of B registered builder, <br />The work will be oerformed by ~ registered builder, <br />Other. <br /> <br />$~GNATL RE OF APPLICANT .... <br /> <br /> DATE; ...................... <br /> <br /> 11485 JAMES WAY SE <br />............... ~U~S~V,I~LE ...................... 0R..._~2~2~5 ................. ~flRI~N._~COU,NZ~.._.N~ ........... <br />JSE OF BUILDING: <br /> <br />OCCUPANT LOAD: <br /> <br /> 3 <br /> <br /> SAME SITE HUMSER; 94-02153 <br /> PHONE-' 749-1287 VALUATION: <br /> <br />~.OT: "'-'"1-~i;~6-~ ...................... § Eb-TF6~-.,''-~ .......... TOWN~h~ .............. RANge. ................ ~ ~6'~E~ ..............'~ <br /> <br />........................ ~L .......................... J_ ........... ~,..~___~ L...U~ __ __-L._NO ................. <br /> <br />TYPE= OH-SITE SE~A~E <br /> <br />PERMIT DR APPLICATIOH HO: <br /> <br />CONTRACTOR. NO. <br />HOWELL/HOOYMAN VIVIAN ~, <br />SAME <br /> <br />PHONE: 747-1207 <br /> <br />55438 <br /> <br /> WATER SUPPLY: PW <br /> TEST HOLES READY: NO <br /> SITE EVALUATION NUMBER: <br /> EXISTING TANK SIZE= <br /> EXISTIN~ DRAIN FIELD L~NES: <br />I'SEPT,IC,TANK PUMPED: <br /> PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM' <br />STANDAR~ ON-SITE SYSTEM <br />SITE EVALUATION, FIRST I <br /> <br />QUANTITY <br /> 1 <br /> 1 <br /> <br />AMOUNT <br /> $2§5.08 <br /> $265.80 <br /> <br />$528.00 <br />$520.80 <br /> $0.00 <br /> <br />$8.00 <br /> <br />PAYEE= RECEIPT NO: <br />RECEIVED BY: DM TYPE: CHECK <br /> <br />SEE DOCUMENT SYSTEM. <br /> <br />NOTE: THIS DOES NOT r. RA~T O~M~Y PERHISSION TO BUILD ON THIS PARCEL. PLANNING AND <br />ONSTRUCTION PERMITS MUST BE,,OB~AI~EB,,B[FORE~BUILI)ING OR SEPTIC INSTALLATION BEGINS. <br /> <br />REMARKS: SE/SS TH:READY 6/~'4Y~4 SEE SEPTIC PERMIT <br /> SITE PLAN 6/16/04 <br />DONALD e. WOODLEY, MARION,OOON'FY"'BU~D~NG"OFFIC~AL'/'BY ............................................................ <br /> <br /> OFFICE COPY <br />PO~M # MC lS-~ REV, 4,90 <br /> <br /> <br />