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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />¢'20 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br /> <br />am performing work on 8 property I own or occupy, <br />~ 8m a registered builder OR ( ) the avthorized representative S~GNATgRE OF APPL CANT'. ................. <br />of ~, registered builder. <br />The work will be performed by a registered builder. <br />Other <br /> <br /> DAI'E: 00109193 'TZHE~ 16~2:~6 .. <br /> <br /> ~UHSWLLE OR 97~2~ <br /> <br /> : GLEN ~ <br /> 7~3~ STONEPIELD CT ~E ~ <br /> AUHSV~LLE OR ~7~25 <br /> PHONE: ~45-6222 VALUATION: <br /> ~ i <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CON'fRACTORv NO. <br /> <br />/¥~ ~IUNE~±~I. 9 CT SE <br />AUMS¥ILLE OR 97~2~ <br />PHONE:: ~45--6222 <br /> <br />WATER SIJPPLY: PW <br />TEST HOLES READY: YES <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXIST]lNG DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS HO. BEDROOM8: <br /> <br /> ITEM QUANTITY AMOONT <br />SITE EVAI. OATION~ EA. ADDL. LOT I $'~o% <br /> .... ~ 00 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$225.88 <br /> $0.00 <br />$225.00 <br /> <br />'BALaNCE,DUE $0.80 <br /> <br />PAYEE: KAII. EY, JOHN M,~ RECEIP~ N~: . 5]307 <br />RECEIVED BY: ~B .~__~ . ~ TYPE: OK CHECK ~:' '&82 <br />oEE ATTACHED DOCUMENT FQR,REQUIREHENT8 oF ON-SITE SEWAGE SYSTEM. - <br /> <br />NOTE: THIS ;OOES NI!T GRANT OR IMPLY PERMISSION TO' BUILD ON THIS PARCEL. PLANNING <br />OI,ISTRUCTION PERMITS NU~T BE OBTAINED BEFORE BUI:LQ]~NG OR SEPTIL INSTAI..LATIUH <br /> <br /> PLAN REVIEW~ BY_ CITY JURISDICTION: BY .................. DATE ................................ <br /> RE~AF(KS~ SE/T~:REA~Y 8i~/93 -- <br /> <br /> <br />