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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 ~ 4:80 <br />24 HOUR' CODE-A-PHONE: 588-7904 <br /> <br />r have re~d ~r,d agree t~ the t~rms stated On t~b"~eveme ~'i¢~e o! <br /> <br />F'ILE <br /> <br /> DATE: 05/05/93 TIME: 11:28:Z7 <br />' ~wN~.i .................................................................. f.~ i"6'f ~ ................................ '. ~bbn~:' <br /> HO~ERN ~UILDIN~ SYSTE~ IHC 6~5~8-~ · COH~ERCZAL <br /> <br /> AUHSV~LLE,~493 PORTER RD OR , ;~ ~OUHTY, NO ~ ~ <br />"~{~ o~ ~b~6~'~ .... ' .................................. ~ ...............' ..................~ ...................... ' ......... ~,~ ~ s~0~0~s' ' <br /> <br />KENHETH A RASMU$SEN~ P~E. ~82-1422 <br />PO BOX 2.~0 TUALATTN, OR 970~2 <br />PNONE.' 749-494? <br /> <br />SITE NUHBER: <br />VALUATION: <br /> <br /> 6 : 9S i iW ~ L . 6~ <br /> <br /> : ~ · 35. ! AC i NO i N0 <br /> <br /> TYPE: ON-SITE SEWAGE --~_L.-..~.~ WATER SUPPLY <br /> TEST HOLES REA9Y: <br /> PERHZT OR APPLICATION ~O: SITE EVALUATION NUMBER: <br /> · ., EXISTING TANK SIZE: <br /> CONTRACTOR. NO. : EXISTING BRAIN FIEL~ LINES: <br />HOD9ERN BUILDING SYSTE~S~ INC~ SEPTIC TANK F'U~PEB: <br />KENNETH A RASAUSSEN, P.E. &82il PREVIOUS NO. BEBROONS: <br />PO BOX 250 TUALATIN, OR ~70&2~ <br />PHONE: 74~-4749 <br /> <br /> [TEN QUANTITY AMOUNT <br />AUTHORIZATION NOTICE r FIEL~ ~I~IT 1 $160.80 <br /> <br /> !. ' PREVIOUS. RECEIPTS <br /> ;.,, :'BALA'NCE'~UE ' , $0.00 <br />PAYEE: NO~DERN BUIL~IN~ SYSTE S "" ," : ,",v · ..... RECEIPT NO: 49148 <br />RECEIVED ~Y: CL · ·' <br /> .............. ~ .......... ; .......... ,, TYPE: CK CHECK ~: 54483 <br />SEE ATTACHED ~OCUHENT FOE REQO~RE'HEN~S OF ~N-SITE'$EWAGE.SYSTEM, <br /> <br /> THAT <br /> <br />PLAN REVIEW: BY _ ATq_.~_ _ ._~_. CITY JURI.SDIC;TIOH: BY ........ DATE ............ <br />R'EMAEK~.- AUTHORIZATi[ON FOR BU'~ 'T. ~' <br /> <br /> <br />