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MARION COUNTY BUILDING iNSPECTION <br />SENATQR BLDG. NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-514? 8;00 - 4:30 <br />34 HOUR CODE-A-PHONE: SSS-7~KM. <br /> <br /> Other, <br /> <br /> ~UBBERD, T~ <br />i SlT~i%~'h~ ~~ <br /> <br /> 90148-04~ ! RESIDENTIAL <br />.............................................................. r b'ci;¥ ~A-~iC¥." '" <br /> I CONSTRUfTT ON typE , <br /> j <br /> <br />14747 ALBER~ WAY ~IE ,¢ONf~CtC,rY~ i UGH t OCC~S~ LO^O. <br /> <br />$995 SE PINEBROOK <br />TIGARD, OR 97224 <br />PRONE: 639-6890 <br /> <br /> A.~R$ CREST ADD ~ - . <br /> SITE ~e(: 94-00697 : <br /> YALUAT~ON: <br /> <br />........ i ~:ow~s~i~ .......... i"~'~'~E: ................ ,r~ON~ ............. q-i~, ...............' <br /> <br />PER~[T OR APPAICATION NO: 90529?0 <br /> <br />~ATER SUPPLY: P~ <br />TEST HOLES READy: <br />SITE EVALUATION NUMBER: ALBER$ ADD <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br />CONTRACTOR, NO. 33830 <br />DENNIS SIBBIO~S-PRICZ RITE SEPT <br />18220 NE ~ILLS~DE DR NEWBERT, <br />N~WBERG, 97~32 <br />PHONE: 538-2276 <br /> <br /> ITEM QUANTITY AMOU~ZT <br /> STANDARD ON-SITE SYSTE~{ : I $255,00 <br /> <br /> · TOTAL ASSESSED FEES $255.00 <br /> PREVIOU~, RECE'TPTS $0. O0 <br /> :.-, YHIS ;,,RECEIPT $255.00 <br /> <br />· ,' ..... so.oo <br />PAYEE: DE~3 GIBBIO~S~RIC~ RITZ $~P~I~':"~':'?.":;:'. '...'.'. '.:":" INVOICE NO: 55430 <br />RECEI.VED BY. Ch · '~ .. : ........... TYPE: ~N CHECK ~: 0 <br />SEE ATTACHED DOCUMENT FOR 'R.EQU~.R~TS, OF ON-SITE SEWAG~ SYSTEM. <br /> <br />FOLLOWING ~UST BE CO~LE~D.. IT' I.S THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br /> , .:, ':..:,'.'..,',,..:,.,. ...',. ... <br /> <br />PLAN R~IE~: BY.,, DATE~. , CITY JURiSDICTiON: BY D~Tg <br />REMARKS: PERMIT <br /> <br />~oR. ,,~ .~.~ ,E~. ~ OFFICE COPY <br /> <br /> <br />