Laserfiche WebLink
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 /> DATE;; 0,5/27197~ TINE." :LS,~ 38.~:L7 <br /> <br /> MODDERI,I BLJII_D]ZR6 oYoTEMo,~ Ii,lC <br /> <br />SITUS ADDRESS' <br /> <br /> 949; F'ORTER RD <br /> AUMSV II.,.I.,,E, OR 977525 <br /> <br />PILE <br /> <br />CONSTRUCTION TYPE' <br /> <br />q~, STq°~QUN'f y <br /> <br />OCCUPANCY: <br />iOCDUPANTJ~AD~ <br /> <br />MAILING ADDRE~Si <br /> <br /> KEI,INETR .,A# RASMUSSEN, <br /> PO BOX 250 T'UAI_AT:[N, <br /> PHONE: 749-4949 <br /> <br />OF( 970~2 <br /> <br />SUBDIVISION <br /> <br />........ S~tE"HO~E~:'" <br /> VALUATION: <br /> <br />LOT. BLOCK: SECTION TOWNSHIP: <br />WIBl'lh DEPTH' ARE~ ~. 'UNIT,~c <br /> <br />RANGE'. ZONE. <br /> TL <br /> <br />, MAP: <br /> <br />TYPE: ON-SITE SEWAGE <br />PERi, IT OR APPLICATION NO: 9847377 <br /> <br />CONTRACTOR~ NO. , <br />NODDERN BUILDIN~ SYSTENS,~ <br />~ENNETH A RAS~I.ISSEN.~ P.E. 889~1 <br />FO BOX 258 TUALATIN.~ OR 97862: <br />PHONE:; 74~'-4~49 <br /> <br />WATER SUPF'LY <br />'¥ES7 HOLES READY: <br />SITE EVALUATION NIJ~BER: <br />EXISI'~N6 TANK SIZE: <br />EXISTING gRAIN F]iEL~ LINES: <br />SEPT]:C TANK F'UMPE~: <br />PREVIOUS NO. BE~ROOfiS: <br /> <br /> ITEH ; <br />A[JI'FIORIZATION NOTICE - FIELD VISIT <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />;tHIS RECEIPT <br /> <br />BAIL~I,ICED[JE <br /> <br />QUANTITY AHOOI'.IT <br /> 1 $,1,60., 00 <br /> <br /> PAYEE: NO~)I)ERN BUILDII, G SYgTEMs~ INC RECEIPT NO: 49642 <br /> RECEZVEQ BY: cl ......................... ~ .................. ~ .... ~ TYPE: CK CNECK ~: 54793 <br /> SEE ATTACHED DOCUHENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br /> *THZS ZS NOT A PEEHZT. THIS APPLICATION HUST ~ THEOUGH A REVZE~ PRO~ESS NHERE THE <br />IrOLLOW][N6 MUST PE COMPI,,.E'f'Eg. THE RE~PONSIBI[,ITY OF THE APPLICANT TO A?SbRE THAT <br />ALI NECESSARY ~IIFO~MATIOII HAS B~EN <br /> <br /> OFFICE COPY <br />FORM # MC 15-5G REV. 4/90 <br /> <br /> <br />