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MARION COUNTY BUILDING tNSPECTiON <br /> 'SENATOR BLDG. NO. 225 <br /> 220 HIGH STBEET NF <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4::BO <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> P <br /> am ~ registered bV Ide¢ OR ( ) the autho({zed ¢¢0 esentative <br /> <br />Other~ , <br /> DATE:'85/27/~ Tt~E; 15:~&:~7 <br /> <br /> ..................... ', OO,ST~o~O, <br /> <br /> ~4~3 FOETER R~ SE .............. ,, <br /> AUHSVILL, E~ OR ~7325 ~SNC~UNTY, u~ <br /> <br /> ....................................................................... ; ~-o, '0;' ~;~ooMs <br /> <br />KC'HNETH A R.A, SHUSSE~.~ P.E. ~, <br />PNONE: 749-494~ VALUATION: <br /> <br />~ 6 : 9S ZW IL ~ 68 <br /> <br />TYPE: ON-SIT~ <br />PER~IT 0~ APPLICATION NO: 9~47277 <br />CONTRACTOR, NO. <br />~ODDERN BUILDING SYSTEMS, <br />K~NNE'FH A RASMUSSEN, P.E, 682T1 <br />PO BOX 250 TUALATIN~ OR <br />PHONE: 747-4~4~ <br /> <br />WATER SUPPLY <br />TEST HOLES READY: <br />SITE EVALUATION flUHBER: <br />EXISTIN~ TANK SIZE: <br />EXISTING 9RAIN FIEL~ <br />SEPTIC TANK PUMPED: <br />PREVIOU~ NO. BEDROOMS: <br /> <br /> ITEfl ; QUANTITY AMOUNT <br />AUTHORIZATION NOTICE - FIELD VISIT I $160,0~ <br /> <br /> ' TOTAL ASSESSED FE£~ $168.00 <br /> i PREVIOUS RECEIPTS <br /> .' 'i. ' . ~HIS, RECEI~T <br /> <br />PAYEE:RECEivEDMODDERNBy: ciBUILQ[NG"SY~TE~S;'"INC ..... .... ,,, · ..c ..... .. RECEIPT NO: <br /> ............. ~-4 ....... ~ ............ "' TYPE~ ~K CHECK f: ~3 <br />sEE AT,AC,ED oc. E.T OR' EO IRE"E TS ON-SITE WAGE YSTE . <br /> <br /> OFFICE COPY <br />FORM # t~C 1 ~-5~ REV. 4/90 <br /> <br /> <br />