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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 />I am performing work on a Broperty I own or occupy <br />lamaregisterodbuilderOR( )theauthorizedrepresentatlve <br />of a registered builder, <br />The work will be performed by a reSiStered builder. <br />Other <br />I have read and agree to the terms stated on the reverse side of <br />this document, <br /> <br />OWNER' <br /> I;RAVE S.,. LARRY <br />SITUS ADDRE ~iS. <br /> <br /> ??50 STOHEFT. I;LD CT <br /> AUHSV:II,I.E. <br /> <br />GSE GF BUILDING <br /> <br />MAILING ADDRFSS' <br /> <br /> SE <br />97525 <br /> <br />PHOP, Es 585.",2:i. 81 <br /> <br />TAX LOT' CATEGORY: <br />74730,.-012 RESIDENTIAL <br />CON~TA'UbTION TYPE' ' d~CUI~ANC~. <br /> <br /> CONTRACT SiT,Y: UGB'. OCCUPANT LOAD: <br /> MARION COlJNTY NO <br /> <br /> NO OF BEDROOMS <br /> <br />SUBDIVISION: <br /> <br /> STONE GLEN <br /> <br /> SITE NUNBER: 94-0127;~ <br /> VALUAT:[ON.. <br /> <br />LOT. BLOCK' SECTION: TOWNSHIP' <br /> 26 8S <br />1,,5 <br /> <br />RANGE ZONE'. MAP: <br /> <br /> 2W AR 5:L <br /> RREG. LOT: CORNER; <br /> NO NO <br /> <br />TYPE-- ON-SITE SEWACE <br /> <br />PERMIT OR APPLICATTON NO: 9~S39~6 <br /> <br />CON/'RACTOR, i,lO. 361':28 <br /> DWAIN BETFIE:iL & SON,~:; EXCAVA')]:ON <br />PO ~40X 5~4 <br />TNRNER,~ 97~9~ <br />PHONE: 7 ~;~-2;il 4::'~ <br /> <br />WATER SUF'PLY <br />TEST HOLES READY: PW <br />SITE EVALUATION NUMBER: 48974 <br />EXISTINC TANK SIZF:: <br />EXISTIN6 DRAIN F'IEL;D LINES.. <br />SEPT];[;; TANK PUMPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEH QUANTITY AHOUNT <br />SAND ~: II,.FER 1 ~14,~,~,, Of~ <br /> <br />TOTAL A,~oESSE;D FEES <br />PREV;(OUS RECEIPTS <br />THIS RECEIPT <br /> <br />$4~J 5,. 00 <br /> $0.00 <br />$455.00 <br /> <br /> ' T~ALANCE DUE $0.00 <br /> !..~Y.E.L~.. ~A[~Y F!U.,TZ ,~ //. ,¢'~ /~ RECEIPT hO: 56S70 <br /> <br /> SEE ~'rTnCHS~) ~BCt. JHE;41' F~--~RE~' ON-SITE SEe~ ~7 ............................................... <br />~ THIS IS NOT ~ PERMIT. THIS ~PPLIC~TION HUST 60 THROUCH A REVIEW PROCESS WHERE THE <br />F'OLLOHZNG HUST ~E COHPLETE~. [T[S THE EESPONS~SZL,~TY OF TI4E ~PP[.,[C~NT TO ~SStJF4E 'TN~T <br /> <br />OFFICE COPY <br /> <br /> <br />