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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br />FILE <br /> <br /> PHONEi588-5147 8!00- 4:30 <br /> 24 HOUR CODE-A-PHONE:'588-7904 <br /> <br /> I am performing work on a property I own or occuDY,J ' ' /~,,~ ~ <br /> 1 am a registered builder OR ) the authorized representative SIGNATURE OF APPLICANT:~~ <br /> Of a registered buHde[. , · <br /> <br /> The work will be pedormed by a registered builder. ; ' <br /> Omar · <br /> <br /> I have read and agree to the terms stated on the reverse rde of DATE; ......................... <br /> <br /> DAVID~ON, JOHN 4e~18-000 RESIDENTIAL <br /> tutus AOOnESS; ~B~f~ b~[b~-V+'¢~' ........ OCCUPANCY; <br /> <br />~ 1892:l MARTIN LN NE CONTRACT CITY ..... OCCUPANT LOAD <br /> AMIr(ORA OR 97~2 MA~ION. COUNTY NO <br /> <br /> ....... <br /> <br /> B ......................................... <br /> 547 SE 7TH PORTL~Ng~ 772~5 S~TE HUmbErt ~ <br /> I HONE.. 253-2847 VALUATION: <br /> <br /> ~.~¥ ......................... ~'C~)'~"~'~ .................. S~bT'~'IS'~? ..... : .... '~-~-SHI~P~ .... R-AN~; - - -~ Z~NE:-- ' MAP <br /> <br />........................... J-_.~- ............ -L ~ ....... : ......... ~u .................. ~.._.~ .......... , ~ ~ <br />{W OTH DEPTH'. AREA; ; UNIT~: ~ IRREG. LOT'. ~ CORNER; <br /> .............. [ .......................................................................................... <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATIQH ilO: <br /> <br />CUNTRACTOR, NO. <br />DA¥IDSQN~ JOHN <br />WALTER B BOYLES <br />547 SE 7TH PORTLAND~ '~'7~"' <br />F'HOHE: 253-2847 <br /> <br /> WATER SUPPLY <br /> TEST HOLES READY: YES <br /> SITE EVALUATION NUMBER: <br /> EXISTING TANK SIZE: <br /> EXISTING DRAIN FIELD LINES: <br /> SEPTIC TANK PUMPED: <br />~ PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM QUANTITY AMOUNT <br />SITE EVALUATION~ EA. ADDL;..L:OI 1 $225.00 <br /> <br /> ', .:,~REV ~'OU,S. EEC'E~ PTS <br /> ,, ~,I'I'ZS,, ~ECE ~'p T $225. <br /> <br />SEE ~TT&CHE~ <br /> <br />NO, TE: THIS DOES NO'~,~ANT OR ]:,MF'tY ~ERMISSIOH TO BUILD [N THIS PARCEL, PLA,NING AND <br />ONSTRLtCTION PERtSlTS/~S"£.[~ B~ OBTAINED, A ,./~BEFORE" BUILDIN~ QR SEPTIC INSTAELATION BEGINS,, <br /> PLAN <br /> RE'VIE~ <br /> <br /> REH~RKS,.I SE- Tl-I= <br /> <br />FORM # MC 16,~4~ REV, <br /> <br />OFFICE COPY <br /> <br /> <br />