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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. NO. 225 <br /> · 2¢O HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br /> CODE-A-PHONE 4:30 P.M. - 8:00 A.M. <br /> <br /> ./i am a registered builder OR the authorized representative SIGNATURE OF APPL CANT: <br />of a registered builder, <br />.~ The work will be performed by a registered builder, <br />Other. <br />I have read and agree to the terms stated on the reverse side of DATE: <br />this docurnent, <br /> <br />~xT~ :" 01/02/90 TIME; 9:06;29 <br /> 81 ELENSERG. 'T'IM <br />SITUS ADDRESS: <br /> <br />61964-000 <br /> <br />RESIDENTIAL <br /> <br /> 7925 HILTON LANE SE <br />TURNER OR 9?392 <br /> <br />~tA~ION COUNTY <br /> <br />UGS: <br /> <br /> NO <br /> <br />OCCUPANT LOAD~ <br /> <br /> 5 <br /> <br />MAILING ADDRESS: <br /> <br />2 <br /> <br />11314 MILL CK RD <br />AUMSVILLE, ORE 9?325 <br />PHONE; 789-2090 <br /> <br />SECTION; <br /> <br /> 28 <br />AREA; <br /> 60. <br /> <br /> SITE NUMBER: 9t38 <br /> VALUATION: <br />TOWNSHIP: T~A~E: Zb~E: <br /> <br /> 9S 2W EFU <br /> AC NO YES <br /> <br />MAP: <br /> <br />TYPE; 0N-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: 9021071 <br /> <br />CONTRACTOR. NO. 349t6P-2 <br />STAYTON MILL CITY SILVERTON SEP <br />41155 STAYTON SCIO DRIVE, SE <br />STAYTON, OREGON 97383 <br />PHONE: ?69-2302 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUI'48ER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO_ BEDROONS: <br /> <br /> ITEM QUANTITY AMOUNT <br />ALTERATION 1 $145.00 <br /> <br /> ~¢_..~/~~) TOTAL ASSESSED FEES $14S.00 <br /> PREVIOUS RECEIPTS $0.00 <br />S~ THIS RECEIPT $145.00 <br /> <br />PAYEE: 8IELEN8ERG, TIM <br /> <br />BALANCE DUE $0.00 <br /> <br />RECEIPT NO: 22344 <br /> <br /> RECEIVED BY: c] TYPE~* CK CHECK ~: 6289 <br /> <br /> SEE ATTACHED DOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br />= THIS IS NOT A PERMIT. THIS APPLICATION MUST 60 THROU(~{ A REVIB PROCESS ~HERE THE <br />FOLLOWING Iz/jST BE COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSUP. E THAT <br />ALL NECESSARY INFORMATION HAS BEEN PROVIDED. <br /> <br /> REVIEW, CITY . RISDICTION, .V <br />REMARKS: ALTERATION <br /> <br />DATE ......... <br /> <br />"O~M" MC ~'~ ~r, nov e/87 OFFICE COPY <br /> <br /> <br />