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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG, NO. 22:5 <br /> 220 HIGH STREET NE <br /> .,SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br /> CODE-A.PHONE 4;30 RM, - 8:00 A,M, <br /> <br />1,~ I ~m a registered builder OR ) the authorized representative SI~NAYLIRE OF APPLICANT: <br /> <br /> 09/21/90 TINE= 13.*37.-36 <br /> <br />S~TUSADDRE~JE~KO, NIKE AND RITA <br /> <br />CATEGORY: <br /> <br />OCCUPANCY: RESIDENTIAL <br /> <br /> 24031 SCHULTZ RD <br />uC~J, O~,.G OR 9?002 <br /> <br />NE <br /> <br />MARION COUNTY NO <br /> <br />4 <br /> <br />28035 ,~ PARKNAY ~? <br />HILSC~VILLE, OR 9?070 <br />PHONE; 682-5848 <br /> BLOCK: <br /> <br /> SITE NUNSER: 96?2 <br />TO~VNSNJP: ~A~ALUATION: ZONE: <br /> <br />MAP: <br /> <br />WIDTH: DEPTH: AREA: <br /> <br />TYPE~ ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />OONTI~CTOR. NO. <br />OUBENKO, MIKE AND RITA <br />28035 S~ PARKWAY ~? <br />NILSONVILLE, OR 9~070 <br />~E: 682~5848 <br /> <br />9022590 <br /> <br /> WATER,SUPPLY: P~ <br /> TEST HOLES READY: <br />SITE EVALUATION NUrflBER: 85-501 <br />'EXISTING TANK' SIZE= <br /> EXISTING DRAIN FIELD LINES: <br /> SEPTIC TANK PUMPED: <br /> PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM (~UANTITY <br /> STANDARD ON-SITE SYSTEM 1 <br /> <br /> TOTAL ASS~ED FEES <br /> PREVIOUS RECEIPTS <br /> ,THIS RECEIPT <br /> <br /> BALANCE DUE <br /> <br /> PAYEE: DUBENKO, MIKE AND RITA RECEIPT NO: <br /> RECEIVED BY= c~ TYPE= CK CHECK <br /> <br /> SEE ATTACHED DOCUMENT FOR REQU~R,B~,,EtC, T~',,OE,ON,-SITE'SENAGESYSTEM. <br /> <br />FOLLONIN~ Md~T BE COMPt. E'TED~; ~%,,,,~$,THE ,,RE~IBILII~ OF 'THE APPLICANT TO ASSURE 114AT <br />ALL NECE~RY INFORMATION HAS BEENPROVIDED; <br /> <br /> ANOUNT <br /> $165,00 <br /> <br /> $165.00 <br /> $0,00 <br /> $165.00 <br /> <br /> $o oo <br /> <br />23949 <br />1782 <br /> <br />PLAN REVIEN: 8Y.,,,......,~.~, <br />RFJ'4ARKS: PE~IT <br /> <br />CITY JURISDICTION; 8Y .................. DATE .......................... <br /> <br /> <br />