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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:$0 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performing work on a property I own or occupy, <br />t arr~aregistered builder OR( ) the authorized representative <br />of a r~gistered builder, <br />The work will bo performed by a registered builder, <br />Other. <br /> <br />SIGNAIURB OF APPLfCANT: <br /> <br /> DATE: <br /> <br />()WNPC~I'E~ 01/2.8/92 II'CIE: 12:1.3:38 <br /> PE I'ERSON, Ri C~ARO <br />S~TUS ADDRESS <br /> <br />TAX LOT: CATEGORY: <br />CONSTRUCTI JN TYPE OCCUPANCY· <br /> <br />RESIDENII~L <br /> <br />15109 SECOND S'F <br />AURORA OR 97002 <br />USE OF BUILDING. ' ............ <br /> <br />Nk <br /> <br /> '~NTRACT CITY UGB ~CCUPANT LOAD: <br /> <br />AURORA NO <br /> NO OF ~FDROOM$ <br /> <br />~AILIN~ ADD~ESS: <br /> <br />SUBDIVISION <br /> <br />P.O. BOX 349 <br />AURORA, OR <br />PHONE: <br /> <br />; LOT: <br /> <br /> PARCEL .2 <br /> <br /> SiTE NUI'4BER: 92-00524- <br /> · . VALUAT ION: <br />BLOCK: SECTION ........... ~O~VNBR P ' ' RANG~ ~ONE; " MAP: <br /> <br /> ...... ~.~ .................... <br /> <br />TYPE*. ON-SiTE SEWAGE <br /> <br />PER~i'I' OR APPLICATION NO: 903,80,98 <br /> <br />OONT~TOR, NO. <br />PE'rERSON, RICHARD <br />P.O. 8OX 349 <br />AURORA, OR <br />PHONE: <br /> <br />~NAI'ER ,SUPPLY: ON <br />rEST HOLES READY: <br />5J. TE gVALUA'fIr.~ NUIV~ER: <br />E..~IS'F lNG 'rANI< <br />EXISTING D~IN FIELD LiNE~: <br />SEP'r iC 'F~K <br />PREVi~S NO. <br /> <br /> l 'FEN <br />SiTE EVALUATZr..I~, FIRST LU'I <br /> <br />PAYEE: PETERSCN, RICHARD <br /> <br /> QUANT i 'f'Y AI",IOU N T <br /> 1 $180.00 <br /> <br />TOTAL ASS~ED FEES $180.00 <br />PREVIOUS RECEIPTS $0.00 <br />tHIS R~CEiP'r $180.00 <br /> <br />BALANCE BOB <br /> <br />INVOICE NO: 40064 <br /> <br />RECEIVED BY: C'I TYPE: iN CHECK ~: 0 <br /> <br />SEE ATTACHED [YOCUMENT FOR REQUIREMENTS OF ON-SiTE SEWAGE SYSTE~_ <br /> <br /> E O~TA~NEO, 8EPORE BUILDING OR SEPTIC INSTALLATION <br /> ,_AN REVIEW, .............. .......................... ............... <br /> <br />R~A~K~: 5E <br /> <br />OFFICE COPY <br /> <br /> <br />