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MARION COUNTY BUILDING INSPECTION <br />SENATOR SLDG, NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 58S-5147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I :~m performing work on :~ property I own or occupy. ~~. <br />I am a regigtered builder OR { ) the authorized representative SIGNATURE OF APPLICANTZ <br />of a registered builder, , <br />The work will be performed by a registered builder.: <br />Other <br />I have read and agree to the ~erms stated on the reverse side of DATg: <br /> <br /> DAI'E~ 0~12f~193 <br />OWNER: <br /> D~VIDSON~ JOHN <br /> <br />T ]: M E.." · .11 d 57; 47 <br /> <br /> 10920 NAR'TIN LN ;,IF. <br />AORORA OR 97002 <br /> <br />TAX LOT <br /> 4(,Jl;}:i. 8- 000 <br />SONST RUCTION TYPE <br /> <br />MARION COUNTY bio <br /> <br /> CATEGORY: <br /> RESIDENTIAL <br /> <br />; O¢CtJ PAN~ LOAD: <br /> <br /> 4 <br /> <br /> WALTER I%0~ ES <br /> E;47 SE 741'F PORTLAHD 97215 SITE NUMBER: 93-83239 <br /> PHONE: 25~-2847 VALUATION:: <br /> <br />LOT: ' ' ~LOCK ........ SECTION; ....... fOgN~[~ .... ~*NGE:' .................... ~¢~ ............... [ ~Z'P:' ' <br /> ~ 1.5 ~c NO NO <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION biO: <br /> <br />BOHI RAC,,TOI% NO. <br />])AVIDSBN.~ ~JOHN <br />WAL, TER BOYES <br />54'2 SE 74TH PORTLAND ~7215 <br />PHON~:: 25~-2847 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXiStING ~RAIN FIEL~ LINES: <br />SEPTIC TANK PUMPED: <br />PRE¥IOUS NO. BEDROOMS: <br /> <br />:(TEM QUANTITY AMO(JNT <br /> <br />SITE EVALUAT]:OH, FIRST L'OT 1 <br /> <br />TOTAL ASSESSE9 FEES <br />PREVZ00S RECEIPTS <br />THIS ~EC1EIPT <br /> <br />BhLANCE DUE <br /> <br />REf, EIVED ~.Y,, QL ~ ....................... <br /> <br /> RECEIPT NO: <br />TYPE: CK CHECK <br /> <br /> $265.00 <br /> <br /> $265.00 <br /> $0.00 <br /> $265~00 <br /> <br /> ~0.00 <br /> <br />5241:[ <br /> 1816 <br /> <br />SEE All'ACHED DOCUMENT FOR REI~UEREMENTS OF ON-SITE SEWAGE ,SYSTEM. <br /> <br /> NO'¥'r-": THI[,~ DOE,~ blOT,GIlA TO BUILD ,,O,N THY$ PARCEL, F'LAINING AFD <br /> ('/N,~3TFiUCTION F'EF:MiETS ii~U~T BE OBTAINED,BEFORE BUILDING OR SEPTIC INSTALLATION BEGINS. <br /> . <br /> ...... ..................... ............................. <br />' iq'E:M&RKS:~ SE <br /> <br />OFFICE COPY <br /> <br /> <br />