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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: 558-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />The work will be performed by a registered builder, <br />Other <br /> <br />this document. <br /> <br />SIGNATURE OF APPLICANT: <br /> <br />OWNER:DATE: BP./28Z~.4 IIi~E: .I2= 26." 5~ ....... ;Txx [.5~ ........... i 0AT~b~.. <br />K~Lfl~TIN, PAT 75~I~8& RESIdENTIaL <br /> : CONSTRUCTION TYPE: ~ OCCUPANCY: <br /> <br /> 5750 FILBERT CREEK LAHE SE ~-68~BYBif~: <br /> AUMSVILLE OR ~7~2~ ~ARION COUNTY .~NO <br /> ; NO OF 8EOAOOMS: <br /> <br />MA~LING ADORES8; : SUBDIVISION: <br /> <br />~ 234 NO. CENTER ST. ' .............................................. <br /> SUBLIMITY ?7385 SITE NU~BER: 94-~2685 <br />; PHONE= 769-7§?6 VALUATION: <br /> <br />!LOT; r BLOCK; SECTION; ~ TOWNBH IP; RANGE: i ZONE: MAP <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERitiT OR APPLICATION <br /> <br />CONTRACTOR. NO. 33013 <br /> ACE SEPTIC <br />&220 LAKE LABISH NE <br />SALEN~ 97~05 <br />PHONE= <br /> <br />WATER SUPPLY: PW <br />TEST HOLES REABY: YES <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTIN~ DRAIN FIELD LINES: <br />SEPTIC TANK PUMPEB: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM <br />STANDARD ON-SITE SYSTEM <br />SITE EVALUATION~ FIRST LOT <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS.RECEIPT <br /> <br />~ALANCE DUE <br /> <br />QUANTITY AMOUNT <br /> 1 $265.00 <br /> <br />$520.00 <br /> <br />$0.00 <br /> <br />PAYEE: RECEIPT NO: <br />RECEIVED BY: DH TYPE: CHECK <br />SEE ATTACHED DOCUMENT FOR REQUIREMENTS OF OH-SITE SEWAGE SYSTEM. <br /> <br />NOTE: THIS DOES NOT GRANT OR IMPLY PERMISSION TO BUILD ON 'THIS PARCEL. PLANNIN~ <br />OHSTRUCTION PERMITS MUST ~E OBTAINED BEFORE BUILDING OR SEPTIC INSTALLATION BEGINS. <br /> <br />REMARKS: SE - S$:STB SYS. MAR~INAL ON UPPERMOST SURFACE. PRE-C(~I;rS'T'~UCTION STAKEOUT <br /> RECOMMENDED. ACE SEPTIC. PHONE-393-1033. <br />DONALD E. WOODLEY, MARION COUNTy BU:ILB!NG OFFICIAL / BY <br /> <br />OFF)CE COPY <br /> <br /> <br />