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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: 888-8147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performing work on ~ property I own or OCCUpy. <br /> <br />The work witl be pedormed by 8 registered builder. <br />Other <br /> <br />SITUS ADDRESS; i CONSTRUCTION TYRE'. ~ OCCUPANCY: <br /> <br /> 8163 ~ILL CREEK RD SE ~ CONTRACT CITY'. UGB; ~OCCUPANT LOAD: <br /> ~UMSWLLE OR 77325 M~RIBN COUNTY ~ <br /> <br /> 4 <br /> <br />LOT:  ~dd~ ~ ~E~'~[5~':, TOWNSH P: .] RANGE: ~ ZONE: MAP: <br /> ~ ~ ~ }~ NO ~ NO <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />PFLUG, MIKE & NANCY <br /> <br />PHONE: 749-2207 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES:~/~ <br />SEPTIC TANK >UMPED: 5-94 <br />PREVIOUS NO. 'BEDRSOMS: <br /> <br /> ITEM QUANTITY AMOUNT <br /> AUTHORIZATION NOTICE - FL~. VISIT 1 $160,,0~ <br /> <br /> TOTAL ASSESSED FEES $160.00 <br /> PREVIOUS RECEIPTS $0.00 <br /> THIS RECEIPT $1&0,,0~ <br /> <br /> BALANCE BUR $0.00 <br /> PAYEE: PFLUG~ MIKE & NANCY RECEIPT NO: S8~68 <br /> <br /> SEE ATTACHED DOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM,, <br /> <br /> * THIS IS NOT A PERMIT. THIS APPLICATION MUST.GO THROUGH A REVIEW PROCESS ~NERE THE <br />FOLLOWING MUST DE COMPLETED. IT~IS THE RESPONSIBILITY OF TNE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORMATION HAS BEEN PROVIDED~ <br /> <br />PLAN REVI'EH~ BY ..........DATE <br />m NARt S: SS:AU w/v: sI¥ <br /> <br />CITY JURISDICTION: DY ............. DATE .................... <br /> <br />FORM # MC 16.E6 R~/, 4/~3 OF FICE COPY <br /> <br /> <br />