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MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> <br /> 285 Church Street NE · Room 132 · Salem, Oregon 97301-3670 <br />Office Hours: 8:00-4:30 * Phone: (503) 588-5147 * 24-HR Inspection Line: (503) 373-4427 <br /> <br />DATE/TINE <br />TYPE <br />OCCUPANCY <br />PAGE <br /> <br /> ON-SITE APPLICATION <br />B6/11/96 12:51 ACTIVITY N0 : 96-04187 <br />SP STATUS : APPLIED <br />R-3 SE APPLIED : <br />1 BP APPLIED : ~6/11/1996 <br /> T0 EXPIRE : 12/~1996 <br /> <br />WORK DESC : SF':PRESSURE DIST <br /> <br />EXIST B~I)ROi]MS. PROPOSED BEDRO]NS ~ <br />EXIST ENP!.OYEE: PROPOSED EMPLOYEES: <br />SITE ADDRESS : ~,.S~Z <br /> ~2 HOL,~UISI RP SE AM <br /> <br />CITY: MARION COUNTY <br /> <br />SUBD [VlSi IN : LOT: BLOCK: <br /> <br />CROSS STREET : BATES RD SE <br /> <br />PARCEL. NUMB..R : <br />PARCEL SIZE : 1.SAC <br /> <br />OWNER <br /> NAME : <br /> : <br /> <br />PHONE <br /> <br />APPI.ICANT <br /> NAME : <br /> l' <br /> AD ~RESS : <br /> <br />PFIONE : <br /> <br />DFQ CONIRACTOR: <br /> PHON~ <br /> <br />BORNER.D£NALD E & MARJORtE A <br />8582 HOL. MQUIST RD SE <br />AUMSVILLE, OR <br /> 97S04 <br /> <br />SCHMALTZ KEN <br />F'O BOX 5~41 <br /> <br />~A[EM~ OR ~7904 <br />..~88-1~.I. 5 <br /> <br />VALLEY SEPTIC SERVICE <br />SCHMALTZ KEN <br />(50~) 588-1115 <br /> <br />DEQ LICENSE: 36786 <br /> OCCB: 0071161 <br /> <br />Units Descr iptio'd Fee <br />.1 DEO Surcharge ;~0,, 00 <br /> <br /> Assessed fees : 550.00 <br /> Ad just:merits : .00 <br /> Total fees : 550.00 <br /> F - <br /> A~EE. SCHMALTZ KEN ro~a] p~X~ent's~ 558.~8 <br /> Sa) a~'~ce due : <br /> ********************************************************************************** <br /> <br /> THIS IS HOT A PERMIT. THIS A~ICATIQH MUST g8 THROUGH A REVIEW PROCESS WHERE <br /> SOIL, FEASABILITY AHD IHSTALLAT~H REQUIREMENTS ~E CHECKED PRIOR TO THE ISSUANCE <br /> OF A PERMIT. IT IS THE RESPOHS~BILITY OF THE ~PLICAHT TO AS~RE THAT ALL <br /> soo. <br /> <br /> SI(;~)ATURE OF APPLICANT, <br /> <br />................ FOR OFFICE USE ONLY. THIS IS NO~ PERHIT .................. <br /> HAP: 48R ZONE: AR PROPERTY LOCATOR: <br /> <br /> SEPTIC REVIEW: ~ATE: ZONING REVIEW: DATE: <br /> <br /> <br />