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MARION COUNTY BUILDING iNSPECTION
<br />SENATOR ~LOG, NO. 225
<br />2~0 HIGH STREET NE
<br /> SALEM, OREGON 97301
<br />
<br /> PHONE: 588-5147 $:00- 4:90
<br />24 HOUR CODE-A-PHONE: 588-7904
<br />
<br /> e,(~ ~)edorm ng work on a oroperty I own or occupy
<br />I am a registered bu der 0~: ( ) t~e authorized ~ep~esentetive
<br />
<br />$IGNA'rURI~ OF APP,. CAN-r:.... , .........
<br /> DAT£: .....................
<br />
<br />'i"t~' LOT:
<br />~ 46242-'00~
<br />
<br />; FqES~DEN'r'fA[
<br />
<br /> DAV'~ D,~ON~ ,JDFtN
<br />
<br /> 4~61 R~VERSIDE ~R ~ .............................................
<br /> HCHINNVILLE~ OR ~7~8 ; SITE NUMadE: ~4=~1~2~
<br /> PHON~: 472-~625 ~ VALU~T~ON~
<br />
<br />' { 13. ~ AC ~ NO ~ NO
<br />
<br />WATER ~UPPLY~ PM
<br />TE~T HOLES READY: YE~
<br />SITE EVALUATION NUMBER:
<br />EXISTING TANK SIZE~
<br />EX~STIN~ DRAIN FIELD LINE~=
<br />SEPTIC TANK PUMPED=
<br />PREV.~OU5 NO; ·BEDROOMS:
<br />
<br />TYPE~ OH-SITE SEI~E
<br />
<br />PEP,~IT OR ~PLICA?ION
<br />
<br />CONTRACTOR~ NO.
<br />DAVIDSON. JOHN
<br />4361 RIVERSIDE DR
<br />MCHINNVlLLE. O~ 77128 ,'
<br />PHONE~ 472-282~
<br />
<br />~44~g
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<br /> Il'EH QUANTITY AMOUNT
<br /> STTE EVALUATION~ FIRST LOT': ,' ... ,, , 1 $26%00
<br /> '" ' ' 'FEES
<br /> . ·" ': ', ' · ' TOTAL ASSE~SE~ ~26,,5,
<br /> : ' ...., :'..:' ,, ':.'.'~'PRE~.~OU~ RE~IPT~,
<br /> · :, ' ' ,.'F....'.,', :" '.: :,,',,THIS'. ~CEzPT:.' '. ,' ~.~
<br /> · .: ....... ' '"':,. ','..':' .:' '. '
<br /> PAYEE~ .... -..,: ,:' · . ....... ': -. RECEIPT NO:
<br /> RECEIVED ~Y: P~ .': ,,,,'~".',",..~ ";'. ....... ' TYPE~ CHECK ~
<br /> SEE nTTACHED DOCUMENT '~D~,':~EQU~Efl~N~,~...'OH~ITE '$~AGE ~YSTEH.
<br />
<br />1,103E~ THZS DOEs NOT GRANT OR.'.IHP~Y PERMzSS~ON TO BUILD ON THI5 PARCEL, PLANNING AND
<br />ONS'rRUCTIOfl PERMITS HUST 8E .O~,TA[HE.D ,~EFORE,~UILDIN~ OR $~,P~[C INSTALLnT[Gfl
<br />
<br />DONALD E. bIOODt,.EY~ NAR[ON COUNTY ~UZLD~NG OFFICIAL / BY
<br />
<br />OFFICECOPY
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