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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: 58@-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performing work on a property I own or o¢cul3y. <br />I am a registered builder OR ) the authorized representative <br />of a registered builder. <br />The work will be ¢erformed by a registered builder, <br />Other. <br /> <br />this document, <br /> <br />', ~,~B~TE,~ ' f272879'5 <br /> <br />TIME: <br /> <br />TAX LOT: <br /> <br />OONSTRUCTION TYPE <br /> <br /> CONTRACT CITY: JGE <br /> 8724 GOLF CLUB RD <br /> · pUfl~.~L.L=~ ........................... ~_._?Z~?-E ......... EARION COUNTY <br />0SE OF BUILDING: <br /> <br />OCCUPANT LOAD[ <br /> <br />, NO OF BEDROOMS <br /> <br /> EMERY & SONS <br /> P 0 BOX :~98 STAYTOfl~ OR 9738;~ SITE NUHBER: 94-02992 <br /> PNONE: 76~-7751 VALUATION: <br />~o'r'. ' [ BLOOI~i ................ ~l~-~¥ibw ................. TO'~;~S' Hi~- .................. A'X h'~W ...............~ di, i~; ....... MAP; <br />iWIDf~; ....... iD~:~TH; ............ ~"~1 ............... (~'~; ............... ll~FE-~TCg: ............E~CE~-~-Ri ......... 48 <br />~ ............. : .................................... 7-5 ........ AC .................... NO ....... NO <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERHIT OR APPLICATION NO= 90570Z2 <br /> <br />CONTRACTOR. NO. <br />SANTIAM GOLF CLUB <br />EMERY & SONS <br />P 0 BOX ~98 STAYTON~ OR 9738~ <br />PHONIC: 769-7751 <br /> <br />WATER SUPPLY <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: NO <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM QUANTITY AMOONT <br />SITE EVAL. - FIRST IO00 GAL. DSF~ I $280.00 <br /> <br />TOTAL ABSESSEB FEES <br />PREVIOUS RECEIPTS <br />THIS,RECEIPT <br /> <br />$=80. O0 <br />$265. O0 <br /> $0.00 <br /> <br /> BALANCE DUE $1%00 <br /> <br />PAYEE: RECEIPT NO: <br />RECEIVED BY: CR .................................. TYPE: CHECK ~: 0 <br /> <br />SEE ATTACHED DOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br />NOTE: THIS DOES NOT GRANT OR IMPLY PERMISSION TO BUILD ON THIS PARCEL. PLANNING AND <br />ONSTRUCTION PERMITS MUST ~)E OBTAINED B~FORE BUlL. DING OR SEPTIC INSTALLATION <br /> <br /> F'LAN REVIEW: BY ............. DATE .............. CITY JURISDICTION: BY ............ DATE; .................. <br /> REHARKS: .d;,. SOIL SUBSTAN~AR~ FOR ANY SYSTE~. MIGHT BONSI~ER W~NTER HOLDING TAHK WITh <br /> OUTLET TO SHALLOW TRENCHES ~UR'.[NG SLIM~ER SEASON, NEED DEQ. DENIED 9/14/94 <br /> <br />OFFICE COPY <br /> <br /> <br />