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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::30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> i am performing work on a property I own or occupy, <br /> I am a registered builder O¢~ [ ) the authorized representative SIGNATURE OF AiSPLICANT: <br /> of a regimtered builder, <br /> The work will be performed by a registered builCer. <br /> <br /> D A R K ,~ J 0 H N R E: S ]: DEE H 'T I A L <br />(OWNER: ] TAX LOT, CXfbGoR~ <br /> <br /> ..... ~ CONTRACT C TY ~ UGB'. ~ OCCUPANT LOAD~ <br /> <br /> PARCEL t THE RANCH i <br /> c, ........................................................... <br /> PHONE: 769-5?65 VALUATION: <br /> <br /> 28 8S ~ 1W AR 48 <br /> <br /> WATER SUPPLY: PW <br /> <br /> ~b~l UK ~LIU~IiUH HU: 6~YI ~ ~iIE EVALIJAI'ION NUHBER: <br /> EXISTING TANK SIZE: <br /> OONTRACTOR~ NO. ~6415 EXISTING ~RAIN F'IEL~ LINES: <br /> CHARLEY NESS BACKNOE SEPTIC TANK FUMPED. <br /> PREVIOUS NO. BEDROOMS: <br /> ¢¢NONE ~ <br /> <br /> ITEM ,t~UANTITY AHC)UN'T <br />SII'E EVALUATION,, FIF'~ST LOT J- ~,280,.(t0 <br /> <br /> TOTAL AE;sESSEI) F'EE~ ¢280,,¢J¢ <br /> PREVIOUS RECEIPTS $28~J,, 8(,t <br /> THIS RECEIPT $0.08 <br /> <br /> BALANCE' DUE $0. ~0 <br />PAYEF.: RECEIPT NO: <br />Rli';CEIYEI) BY: cl TYPE: CHECK ,[~: 0 <br />'F'- ATTACHEJO I)O.CUl'fl~ SEW ........... <br />....' ......... ~ .... i'-fT FOR REOltIREHENTS OF 'ON-SITE' ' AGE SYSTEM <br /> <br />N(~I'I'~;; 'FI.l:(~,~ ]gOES NOT GRANT OR' IMPLY PERMITSSION TO BUILD ON TItIS PARCEL. PLANNIN(;' AH:b <br />¢)FISTROCTION Pk-.RNIT~ HUST lie OBTAIHE]D BEFORE: BIJlLI)IN6 OR SEPTIC INSTALLATION Bi:,(,.,J,N,:,. <br /> <br /> I¢ hAMx,,h. .~E.,, oTD SYSTEN. REr.;OMHENI) STAI~EOU1 BEF, DRE INoFALL <br /> ¥ <br /> DONAL, O E,, HOOOL, F:Y,, MARION COUNTY BIJILDINt# OFFICIAt / BY <br /> <br /> OFFICE COPY <br />FORM # MC 15.5~ REV. 4,/90 <br /> <br /> <br />