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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 />of a registered builder, <br /> <br />Other_ <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br /> DA.J].D,:~t)I], JOHN , 40242"'898 <br />~SITtJS ADDRESS: O0N~fROCTION YY¢~: <br /> <br />RI:! S ]3 D Ei4'F t' A{, <br /> <br /> :1.0499 CI"IAHPOEG RD NE ~N~r~A&~' 6~TY; ;' Ob~: ] OCCUPANT LOAD: <br /> AURORA OR 97902 NARION CSUNTY <br /> <br />iUSE OF BUILDING; <br /> <br /> 4;~61 RIVERS]:DE DR <br /> MCHINNViIJ_E,~ OR 97128 SITE NUMBERD <br /> PHONE; 472,-.2~)2~ VALUATION: <br /> <br />TYPE= ON-SITE SEWAGE <br /> <br />PERNIT OR APPLICATIOW NO: <br /> <br />CONTRACTOR~ NO. <br />DAVID~ON~ JOHN , <br />4361 RIVERSIDE DR <br />MCMINNVILLE, OR 97128 <br />PNONE: 472-2625 <br /> <br />WATER SUPPLY: F'W <br />TEST HOLES READY: YES <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING QRAIN FIELD LINES~ <br />SEPTIC TANK PUNPE~ <br />PREVIOUS NO. BEQROOMS: <br /> <br />I l'EM QUANTITY AMOI]NT <br /> <br />$]:]E EVALUAltON~ FIRST LOT <br /> <br />'rOTAL_ ASSESSED FEES <br />PREVIOUS RECEIPTS <br />/HIS RECEIPT <br /> <br />1 $265.00 <br /> <br />$2~5,,00 <br /> $0.00 <br /> <br />BALANCE DUE $0,. 80 <br /> <br />PAYEE: RECEIPT NO: <br />RE. CEIVED BY: PB ................................................ TYPE: CHECK ~,". 0 <br /> <br />I,IO]E~ THIS DOES HOT GRANI' OR IMPLY PERMISSION TO BUILD ON TMIS PARCEL.. FLAIfNI.,~,' , ,'"' AN1.) <br />1HSTRUCI'.I;OI,I PERMITS HUST 8E OBTAINED BEFORE ;BUILDING OR SEPTIC INSTALLATION IiEC, TI~S,, <br /> <br />REMARK,,,~ SE APPROVED STD SYS <br /> <br />OONAI..I) E., 000DI,,EY~ NARION COUNTY BUII. DII,IG OFFICIAL / BY <br /> <br />OFFICE COPY <br /> <br /> <br />