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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 <br />CODE-A-PHONE 4:30 P.M. - 8:00 A.M. <br /> <br />03/16/90 TINE.~ 9 .~ 59.. 43 <br /> <br />O'tEI STENgE. N, HAROLD <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> DATE: .... <br /> <br />TAX LOT~ <br /> 75301~020 <br /> <br /> 5710 82ND AVE SE <br />SALEN OR 97301 <br /> <br />USE OF BUILDING: <br /> <br />CONTRACT BITY~ UGB; <br />MARION COUNTY NO <br /> <br />MAILING ADDRESS: <br /> <br />805 ROYALTY DR NE <br />SALI~I, OR 97301 <br />PHC~E: 399-9697 <br /> <br /> 14 89 <br />5. 17999983 AC <br /> <br />SITE NUNSER: 9620 <br />VALUAT I ON: <br />RANG~: ZONE: <br /> <br /> 2N AR3 <br />IRREG, LOT: CORNER: <br /> <br /> NO YE~S <br /> <br />CATEGORY: <br /> RE, SI DENTZAL~ , <br />OCCUPANCYI <br /> <br />OCCUPANT LOAD: <br /> <br /> NO OF BEDROOMS <br /> <br /> 4 <br /> <br />49 <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />CHRISTENSEN, HAROLD <br />905 ROYALTY DR NE <br />.~ALFJvl, OR 97301 <br />PHONE: 399-9627 <br /> <br />22408 <br /> <br />WATER E~JPPLY= PW <br /> TEST HOLES READY= YES <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />'EXISTING= DRAIN .FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROOMS= <br /> <br /> ITEM <br />SITE EVALUATION, FIRST LOT <br /> <br />TOTAE-,~EE, SED..FEES <br />PREVIOUS.RECEIPTS <br />THIS'RECEIPT <br /> <br />(~JANTITY ANOUNT <br /> 1 $175.00 <br /> <br />¢175~00 <br />175.00 <br /> $0~00 <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: ......... ,,,',,,,"RECEIPT NO: <br />RECEIVED BY: c] .... ¢,,~:._2:%'c"_%% ~TYPE;t,~',:,;,, CHECK ~: 0 <br /> <br />SEE ATTACHE0 DOCUMENT FOR <br /> <br />NO'F~: THIS DOES NOT GR~NT OR..:,IJ~IPLY.,.:REI~I,.~SION .TO~ BUILD::(~4, TH:tS:~.:~PARCEL. PLANNING AND <br />CONSTRUCTION PEF~IITS I~.IST 8E O6'TAINEO 'BEFORE' BUILDING OR' SEPTIC INSTALLATION BEGINS+ <br /> <br />RF.t~RKS: SE - STD SYSTFJ~t ~ <br />0ONALO E. HOODLEY, MARION COUNTY ~UILD[NG OFFICIAL / BY ................ ] ............................................................... <br /> <br />REV II/~ OFFICE COPY <br /> <br /> <br />