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MARION COUNTY BUILDING INSPECTION <br /> <br />SENATOR BLDG, NO, 225 <br />220 HIGH STREET NE <br />SALEM, OREGON 9T301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />SIGNATURE OF APPLICANTI <br /> <br /> Of a registered buitder. <br /> <br /> ,OA'f'E: 03/29174 'f];Ht}£: 1,,.I0.02 <br />bWNERi <br /> S'~RA~Ih~ FAY W. <br /> <br />CONSTRUCTION fYPE: <br /> <br />CATEGORY: <br /> <br />OCCUPANCY: <br /> <br /> 6728 672~ PETER R;D 8E '86;¥"'¥8i'~9: ..... 0~: ..... ¥CbUPANTLo,~5: <br /> AIJHSVIL. I.E 8R 973~ ; ~fl COUNTY 40 <br /> <br />MAILING ADDRESS; : ~UbOi¢i~iO~ <br /> <br />SANE <br /> <br />PHONE: <br /> <br />747.-2838 <br /> <br />S~TE NUHBER: <br />VALUATION: <br /> <br />WIOTH; ;DEPTH; : AREA'· UNITS'. IRREG· LOT'. CORNER <br />I 10.: AC ~ NO : bio <br /> <br />TYPE: 0N-SITE SEWAGE <br /> <br />PERHIT OR APPLICRTIOW <br /> <br />[;ONTRACTOR~ NO. <br /> <br />PHONE: <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: . 588 <br />EXISTING D~AIN FIEL~ LINES: <br />SEPTIC TANK PUMPED: 2/~/94 <br />PRE¥IOU8 NO. BEDROOHS: <br /> <br /> Il'EH (:~UANTITY AMOUNT <br /> AUTHORIZATION NOTICE - FLD., VISIT 1 $i80,,~¢0 <br /> <br /> TOTAL ASSESSED FEFS $160.00 <br /> PREVIOUS RECEIPTS $0. ~ <br /> THiS RECEIPT $16¢~, Be <br /> <br /> BALANCE DUE $¢. 0~ <br /> PAYEE: STRAWN. FAY W RECL1PT IGC}: 56317 <br /> RECEIVED BY: ~B <br /> TYPE: CK CI,,IECK :~: 25~9 <br /> SEE ATTACHE~ DOCUMENT FOR RE~U:IRENENTS OF ON-SITE sEWAGE SYSTEM. <br /> ~ THIS I~ HOT A PERHIT.' T~iS APPLICATION HUST~ THROUGH A REVIEW PRQgESS WHEre THE <br />FOLLOWING MUST BE COMPLETED. IT IS THE RESPONSIBILITY OF' TNE APPLICANT TO ASSURE THAT <br />AI.,L NECESSARY INFORH:ATION HAS BEEN PROVIDED. <br /> <br />FORM # MO ~5-58 REV, 4/90 OFFICE COPY <br /> <br /> <br />