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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:So <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performing work on ~ property I own or occupy. <br />I arT1 a registered boilder OR the 8tJ hot Zed epresen ave SIGNAYURE OF APPLICANT: <br /> of a registered builder. <br />The work will be performed by a registered builder. <br />Other <br />I have fe~,d and agree to the terms stated on the reverse side of DATE: <br />lhi8 document. <br /> <br /> DATE, 8~/28/94 ...... II.HE, I2. ................ <br /> OWNER'. T~X LOT: CATEGORY: <br /> <br /> AURORA OR ~ARZON COUNTY ~NO <br />~0'~ ~ <br />' <br /> <br /> , SITE ~ER: 74-~3497 <br /> PHONE: 698~79~4 ~ VALUAT~ON~ <br /> <br /> r I EEILI_ <br /> WIDTN. DEPTH'. ~ AREA: i UNITS I RREG LOT I CORNER; <br /> · 45. AC NO I NO <br />....... =: L <br /> <br />TYPE: ON-SITE SEWAG, E <br /> <br />PERHIT OR APPLICATION NO: <br /> <br />CONTRACTOR, I'lO. <br />COYLE~ M <br /> <br />PHONE: 698-7954 <br /> <br />57?64 <br /> <br />WATER SUPPLY: PW. <br />TEST HOLES READY. <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING BRAIN FIELD LINES= <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEN QUANTITY AMOUNT <br /> AUTHORIZATION NOTICE - FLD', VISIT 1 $1&0.00 <br /> TOTAL ASSESSED FEES $:l.~=00 <br /> PREVIOUS RECEIPTS S160. OB <br /> THIS RECEIPT <br /> <br /> ~L~NCE DUE <br /> P~YEE: RECEIPT <br /> RECEIVED ~Y: DM TYPE: CHECK ~: <br /> SEE ATTACHED DOCUMENT FOR REQUIREMENTS OF ~-SITE SEWAGE SYSTEM. <br /> <br />C_~_~. ~. A~VALiD PERMIT g THIS ~IT EXP~ 3~¢ DAYS ~ON ITS ISS~ ~ATE. ~F <br /> U~H<UCT~ON FAILS TO HEET ALL EEQUIREHENT~ OF STATE LAWS AND ~ARION COUNTY ~UZL~ZN~ <br />ZONING ORD~NANCES~ TH~S PERNIT SH~LL BECOME' NULL AN~'VOID. ' <br /> <br />REMARKS: $5: AUTH, <br /> <br />DONALD E. WOODm. Ey, MARION COUNTY BUILDING OFFICIAL / BY <br /> <br />OFFiCe; COPY <br /> <br /> <br />