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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 />of a registered budder <br /> <br />Othor <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br /> COLUMBIA HELICOPTERS <br />SITUS ADDRESS <br /> <br />: TAX LOT <br /> CONSTRUC"ClON TYPE <br /> <br /> 14452 ~RND-F RD <br /> AURORA <br /> <br />gSE 0¢ BLJILOIN6 <br /> <br />OR 97002 <br /> <br />NE <br /> <br />{ C'ONTRAOT CiTY ! UGB <br />NAR'ION 'COUNTY NO <br /> <br />PO BOX 3500 <br />PORTLAND OR <br />,C'>HON E ~ 636-?664 <br /> <br />LOf SLOOK SECTION <br /> <br />~ S'UBCIVISION ' <br /> <br /> SITE NUMBER~ <br /> · ~ ..VALUATION: <br /> <br />UNitS ~S IRR~G LOT ;W <br /> .AC NO <br /> <br /> 02 <br />3.00000 <br /> <br />' CATEGORY <br /> , OMtVlE ~< I C ~ <br />OCCUPANCY <br /> <br />OCCUPANT LOAD <br /> <br /> 1535 <br /> <br />'~O~Ne~ p <br /> YES <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: 4725 <br /> <br />CONTAACTOR, NO. 23372 <br />FRED DOLSEN <br />2590 OXFORO ST <br />WEST LiNN~ ORE 9?068 <br />~40NE: 655-5955 <br /> <br />WATER SUPPLY: ~ <br />T~ST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE; <br />EXISTING DRAIN FIELD LINES~ <br />SEPTIC TANK PUNPED: <br />PREVIOUS NO. 8EOROOI'AS= <br /> <br /> ITEM OUANT I TY AMOLINT <br /> ON.SITE SYS , 10O0 GAl_ 1 ~!20.00 <br /> <br /> TOTAL A,-CA~ESSED FEES [,i 28 02 <br /> PREVIOUS RECEIPTS <br /> THIS RECEIPT <br /> <br /> 8AL~CE DUE $0.0O <br /> <br />PAYEE: FRED DOLSEN RECEIPT NO- 5A58 <br />R'ECE~VED By. ~ TY~E: CK CHECK ~: <br /> ACHEO DOCUMENT ¢OR REQU~REH~TS OF ON-SITE SEWAGE SYSTEN. <br /> ~S ZSA VALID ~E~ZT * ~ZS PE~JT ~PZR~ 360 ~ F~ ~TS ~E <br />~CT~ FA~ TO ~ ALL R~ZR~TS ~ STATE ~ ~D ~]~ ~ BUiLD,N6 <br /> <br />~,:EI'AARINS: REPAIR SEEPAGE TRENCH DR'A~NF2ELD~:: ~ <br /> <br />D©NALD E. WOODLEY, r,,'L~.R~ON COUNTY BUILDING OFFICIAL / 8Y <br /> <br />rOPM , MC; I~ ,G BE~ e,8? OFFICE COPY <br /> <br /> <br />