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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE:588-5147 8:00-4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performing work on a property I own or occupy. <br />I am a registered builder OR ( ) the authorized representative <br />of a registered builder. <br />The work wi[l be pedormed by a registered builder. <br />Other <br />I have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br /> 23766 NE 3RD ST, BUTTEVILLE NE <br />AURORA OR 97002 MARION COUNTY NO <br /> <br />23764 NE 3RD ST BUTTEVILLE <br />AURORA OR ??082 SITE NUF~ER: 94-B1818 <br />PHONE= 670-5639 VALUATION: <br /> <br />~_ .... .1-51 ~ .4~C YES NO~ <br /> <br />TYPE: Off-SITE SEWAGE WATER SUPPLY: PW <br /> TEST HOLES READY: <br />PERi, IT OR APPLICATION HO: ?B54844 SITE EVALUATION NUMBER: <br /> EXISTING TANK SIZE: <br />CON?ACTOR, NO. , EXISTING DRAIN FIELD LINES: <br />CLARE~ DANIEL E. & VIRGINIA G.~:~;:~,~,!~S ~PUMPED: <br />23764 NE 3RD ST BUTTE~LLE PREVIOUS NO. BEDROOMS: <br />AURORA OR 97882 ~ <br /> <br />PHONE: 678-5639 <br /> <br /> ITEM ~' <br />SITE EVALUATION~ EA. <br /> <br />PAYEE: CLARE, DANIEL <br />RECEIVED BY: MB <br /> <br />SEE ATTACHED DOCUMENT <br /> <br />NOTE: THIS DOES NOT <br />8NSI'RUCTION PERMITS <br /> <br />PLAN REVIEW: BY <br /> <br /> QUANTITY AMOUNT <br /> 1 $225.08 <br /> <br /> $225.88 <br /> $0.00 <br /> $225.00 <br /> <br /> $0.00 <br /> <br /> RECEIPT NO: 57311 <br /> TYPE: CK CHECK ~: 16~4 <br /> <br />~YSTEM. <br /> <br />PARCEL. PLANNING AND <br />INSTALLATION BEGINS. <br /> <br />REMARKS: SE - 2ND LOT <br /> <br />' DA ;~TY ~RIB[~i C T I 0 N: <br />Y <br /> <br />BY ........ DATE ............. <br /> <br />FORM # MC 15-~ REV. 4~90 OFFICE COPY <br /> <br /> <br />