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MARION COUNTY BUILDING INSPECTION <br />SENATOR BL©G, NO. 225 <br />220 HIGH STREET NE <br /> SAI-~=M1 OREGON 97301 <br /> <br /> PHONE: 588-514" 8:00 - 4:$0 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />~ am performing work on a property I own or occupy, <br />lama registered builder OR( } the authorized representative <br />of a registered builder, , <br />The work will be pedormod by a registered builder, <br />Other ....... <br />I h~¥e read and agree to the term8 stated on the reverse side of <br />this documen~ <br /> <br />DATE: <br /> <br /> BAT. E: <br />..... <br /> <br /> PRESLEY, <br />SiTt.j ~"X 6~'SB ~: ......... <br /> <br /> .TA~Ez.._12:24.:.14 ......... <br />DAVID <br /> <br />TAX LOT <br /> 8O0 <br />CONSTR US¥1ON TYPE; <br /> <br /> 37 t 0 HOMY'rEAD ROAD SO "~-)NTRAST OIT~ ' UGB: <br /> OR 97302 <br /> .............................................................................................. SALF_:~ ................... <br />USE OF BUILDING: <br /> <br />NO . <br /> <br />SUBDIVISION: <br />......... HOMESTEAD <br /> <br /> RESI CENT iAL <br />OCCUPANCY: <br /> <br /> 3406 ALDOS AVE ~ <br /> SALEM 97302 <br /> PHONE: 581-8922 ~tl'E NUMBER: 9199 <br /> VALUATION: <br />;LOT. ' ~BLOCK; ....... ~EEft6~ .... Ta~NSNIP' ' ~A~G'~ .............. <br /> <br />........ I 7.74 AC YE~ NO <br /> <br />MAP. <br /> <br /> 83-3 <br /> <br />TYPE: Of4-SI'FE SEq~AGE <br /> <br />PERMI'r OR APPLICA'FION NO: <br /> <br />CONTRACTOR, NO. 53599 <br />G RE:NO EXCAVAI'tNG <br />2833 82N0 AVE SE <br />SALEM, OR 9730t <br />PHONE: 581-9573 <br /> <br />25922 <br /> <br />NATER SUPPLY: CW <br />TEST HOLF_..~. READY: <br />~tTE EVAL,UATION NUMBER~ 21242 <br />EXlSTING TANK SIZE; <br />fCD(~TING DRAIN FIELO LiNE;S: <br />SEPTIC TANK F-XJMPEO: <br />P~OUs NO. BEDROOMS: <br /> <br /> (~¢~.NI'iTY AMO~NI' <br />SE < 6 MONTHS OLD 1 $110_00 <br /> <br /> TOTAL Af.S~EE~ED FEES <br />PREVIOU~ RECEIPTS <br /> THI~ RECEIPT <br /> <br />$110.00 <br />$~10.00 <br /> $o.oo <br /> <br />BALANCE f~JE <br /> <br />PAYEE: iNVOICE NO: <br />RECEIVED BY: CL TYPE: CHECK ~: 0 <br /> <br /> SEE ATTACHEO OOCUMENT FOR REQUiREi~tENT8 OF ON-SiTE SEWAGE <br /> <br />~ THIS IS A VALI,D PE~IT:~ THIS ~IT ~I~ 380 ~ ~ i~ I~E ~TE. iF <br />~ST~T[~ FAI~ TO ~T ~L ~I~TS OF ~TATE ~ ~D ~I~ ~NTY BUILDI~ <br />Z~ING O~l~C~, ~15 P~IT ~',8~ NU~ ~O <br /> <br />R~RKS: PERMIT R.~3805 :;, <br /> <br />0C~ALD E. k,/(}ODLEY., MARJ;0N COUNTY BUILDING OFF.~O.[AL / BY <br /> <br />OFFICE COPY <br /> <br /> <br />