Laserfiche WebLink
MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 825 <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 />lem~registeredbullderOR( ) the authorized representative <br />of a registered builder, <br /> <br />Other ..... <br /> <br />SIGNATURE OF APPLICANI': <br /> <br />' SiTUS A D O nE S~'~E'I' ER;~iON, RtG~iARO <br /> <br />T,~)~ ' I~OT: .......... <br /> <br />CONSTRUCTION TYPE <br /> <br />RESIDENFIAL <br /> <br /> CONTRACT CITY <br />15109 SECOND ST NE <br />AURORA .......... OR, 9?002 ............... <br />USE OF BUILDING' AURO~J~, NO <br /> <br />MAILING ADDRESS: SUB[bVISION'. <br /> <br /> P.O. 80X '$49 <br /> AURORA, OR <br /> PHONE~ <br /> LOT BLocK: SECTION'. ..... <br /> <br />,WIDTH. DEPTH; ~R'~ ~' 1 ~ <br /> <br />OCCUPANT LOAD: <br /> <br /> PARC:~L 2 <br /> <br />51TE NUMBER: 92-00524 <br /> <br />TYPE; CW-$iTE SENAGE <br /> <br />PERFIIT OR APPLICATION NO: 38088 <br /> <br />CONTRACTOR, NO. <br />PETERed, R.[ CHARD <br />P.O. BOX ,~a9 <br />AURORA, OR <br />PHONE.- <br /> <br />HATER,SUPPLY: OH <br />TEST HOLE~ READY: <br />BITE EVALUATION NUMBER: <br />EXISTING 'rANK SIZE: <br />EXiSTiNG DRAIN FIELD LINES.- <br />SEPTIC TANK PU~PEO: <br />PREVIOUS NO. BEDROOFIS: <br /> <br /> ['FF..M <br />SITE EVALUATION, FIRST LOT <br /> <br />TOTAL A.SS~ED FEES <br />PREViCUS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DUE <br /> <br />PAYEE: <br />RECEIVED BY: CR TYPE: <br /> <br />SEE ATTAC'HED DOCUMENT FOR RE(:~JiREfftENT5 OF ON-*SiJ'E SPJNAGE.SYSTE'IVl. <br /> <br /> Q~JANTi'I'Y ADIOUNT <br /> 1 $1B0,00 <br />  $180.00 <br /> $~8o.oo <br /> $0~oo <br /> $o,oo <br /> <br />iNVOtC8 NOt <br />CHECK ~ o <br /> <br />NOTE: THIS DOE~ NOT 6P..a,NT OR IMPLY PERMISSION TO BU.ILD ON THIS PARCEL. P[-N~NING AND <br />CONSTRUCTION PERMITS FLIST BE OBTAINED BEFORE BUILDING OR SEPTIC INSTALLATioN BEGINS. <br /> <br />REC4ARKS: SE STANDARD SYS'FEN <br /> _ / <br />DONALD E. ~:X.)OLE¥, MARION COUNTY BUiLDiNG O~'FiCIAL / BY r~.// <br /> ',d%-""- <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 REV. 4t'~o <br /> <br /> <br />