Laserfiche WebLink
MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br />Other. <br /> <br />r have read and ad 6'e to the terms stated on the reverse side <br />this document· <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> SIGNATURE OF APPLrGANT: <br /> <br />mILE <br /> <br /> DATE, 0,.~/0o/9,~ TI. ME. <br />'OWNER'. ~AX LOT: , CATEGORY; <br /> MODDERN BOILDINE- SYS'T~:M~ INC <br /> $1TUS ADDRESS: <br /> <br />dOS18-OOe <br /> <br /> COMMf;,RC IAL <br /> <br />OCCUPANCY: <br /> <br />AUMSVILLE~9493 PORTER RD OR :97.~25SE i ~,,l'ci¥:[00NTY,''6~;NO OCCUPANT~AO; <br /> <br />KENNETN A RgSMUSSEN~ P.E. 682-1422 <br />PO BOX 2ED TU~I. ATIN.~ OR 97962 SITE NU~BE~: 93-~$¢28 <br />PHONE: 749-4949 VALUATION: <br /> <br /> i_ O~f: ....................... BLOCK: SECTION; TOWNSHIP; RANGE: , ZOh~: MAP: <br /> <br /> 6 9S 1W , IL 60 <br /> <br />' : ' ' M5. ~, ~ NO [ NO <br />t ...... ............. : ....... ~ ...........................J ....................... ~ ............ <br /> <br />TYPE: ON-SITE SEWAGE ~ <br /> <br />CONTRACTOR, IqO. <br />~ODDERIq BUILDING SYSTEMS~ INC <br />KENNETH A RASMUS~EN~ P.E. 682vl <br />PO BOX 250 TUALATIN, OR 97062 <br />PMONE: 749-4949 <br /> <br />WATER SUPPLY <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LiNE~: <br />SEPTIC TANK F'U~PED: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM QUANTITY AMOUNT <br />AU'fHORIZATION NOTICE -- FIELD VISIT i $180.1~10 <br /> <br /> : TOTAL A~SESSED FEES ' <br /> m PREVIOUS RECEIPTS ¢8., 8~ <br /> THIS: RECEIPT $16~. 88 <br /> <br /> PAYEE: MODDERN BUILDING SYSTE~S~ tNC RECEIPT NO: 49140 <br /> RECEIVED xBY: CL ............... z_L___ .......................... TYPE:: CK CHECK ~:: 5448~ <br /> ~ ................. r .................. ~-~--- ....... ---=r ......................................................... <br /> SEE ATTACHED DOCOMENT FOR REQUIREMENTS OF ON-S~TE SEWAGE SYSTEM. <br /> * THI~ IS NOT A PERHIT.' THIS ~APPLI~TION MUST ~O THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWIIIG MO~T BM COMPLETED. IT ~ THE RESPONSIBILITY OF THE APPI_ICANT TO ASSORE THA'I <br />ALL HECgSSARY %NFORMATION NA~ BEEN PROVIDED. <br /> <br />r;.'EHARkS: AOTHORTZATION FOR Bu]~LDIMG PERMIT ~ 44721 STILL PENDING <br /> <br />FORM # MC 15-56 REV, 4/90 <br /> <br /> <br />