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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREEET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE; 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />have read and agree to tr, e'~'~'r~s stated oh the'reverse Side <br /> <br />~IGNATUR~ OF APPLICANT: <br /> <br /> CATE; ........... <br /> <br />DATE: ,01/22/9:S , T I~E:, ~.2¢Q3.'2,6 ............. i.t~,~by~ .............................. !'~A~E~6~ .... <br />~HIGLIERI, LORENZO . 40~42-000 , RESIDENTIAL <br /> ....................... .' 'GO N S r ~UO~'idN' W~ .................. ~GOPANGY: <br /> <br /> 12993 EHLEN RO NE :"~R~ ~i~; "'~Oo~r ....... OCCU~AN~ LOAD: <br /> hUROR~ OR 97002 [ MARION COUNTY~ NO : <br /> <br />LOT; <br /> <br /> PHONE: : YALUAT ION: <br /> ......... : ~-d~ ~i ............. ~6~'s'~ ~'~.. ......... ~ '~i ............. ~'~d~: ....... <br />..... ....... ..... .......... ....... · , <br /> <br /> ; 60. ~ AC N0 ~ N0 <br /> <br />TYPE: ON-SITE DE~GE MATER SUPPLY: PW <br /> <br />PERMIT OR APPLICAT]~ON NO-" 442Z2 <br /> <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING ORAIN FIELD LINES: <br />SEPTZC TAN~ PUMPED; . <br />PRE¥IOU$ MO. BEDROOMS. <br /> <br />CONTRACTOR, NO~ <br />B.P. ABLES <br />PO BOX <br />DANBY, ~7013 <br />PHONE: 26~-2271 <br /> <br /> ITEM QUANTITY AMOUNT <br />SITE EVALUATION, FIRST LOT 1 $2~o,0o <br /> <br /> TOT~L'~$$ESSEO FEES $220.00 <br /> r,' .PREVIOUS 'RECEIPTB $220.00 <br /> ,'"'.'.' .THIS RECEIPT $0,00 <br /> <br />PAYEE: .... ' RECEIPT NO: <br /> <br />SEE ATTACHED 00OUMENT FOR'REQUIREMEflT~ OF 0N-SITE SEWAGE SYSTEM; <br /> <br />NOTE: THIS OOE$ NOT GR~NT OR ;IMPkY PERMISSION TO BUILD ON THIS PARCEL. PLANNING ANO <br />ONSTRUCTION PERMITS MUST BE OBTAINED BEFORE BUILDING OR ~EPTIC INSTALLATION BEGINS. <br /> <br />REMARKS; 3ITE EVAL APPR. STP <br />DONALD E. WOODLEY, MARION COU!NTY BUILDING OFFICIAL / BY <br /> <br /> <br />