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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 /> I am performing work on a property I own or occupy. <br /> I&maregisteredbuiBde¢OR( } the authorized representative <br /> of a registered builder, <br /> The work will be performed by ~ registered builder. <br /> Other <br /> I have read and agree to the terms, stated on the reverse 8ida of <br /> this document. <br />DATE: 08/20/8? TINE: 12:50:19p <br /> HUMMEL, BILL <br /> <br />~ITUB ADDRESS; <br /> <br /> 215 FRONT ST <br />DETROIT OR 97942 <br /> <br />TAX LOT; i CATEGORY; <br />CONSTRUCTION TYPE: ~1 ~C~UPANcY: <br /> ', OCCUPANT LOAD'. <br /> <br />USE OF BUILDING; <br /> <br />MA~LING ADDREBS: <br /> <br />14695 ~ 135RD <br />T~GARD, OR <br />PHONE: <br /> <br />LOt: BLOCK: <br /> 8 !'7 <br /> :D[PTH <br />W~DTH: 50 <br /> <br />RESIDENTIAl_. <br /> <br />DETROIT ~ <br /> ! HANNOND <br /> <br /> ~ SITE NUMBER: 2271 <br /> VALUATION: <br /> <br /> RANGE: ZONE: <br /> 1 ~ 10 5E ~ 105 <br />100 <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: 9003893 <br /> <br />CONTRACTOR, NO. <br />HUMNEL. 8ILL <br />14695 ~ I~3RD <br />TIGARD, OR <br />PH~E: <br /> <br />WATER E~JPPLY: . <br />TEST HOLES READY: ~ <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />~ISTING D~IN FIELD LINES: <br />SEPTIC T~K <br />PREVI~S NO. BEDRid: <br /> <br /> ITEJfl <br />SITE EVALUATION, FIEST LOT <br /> <br />PAYEE: HUMMEL, BILL <br /> <br />QUANTITY AIvE)UNT <br /> $165.00 <br /> <br />¥OT~L AEx.~ESSED FEES <br />PREVIOUSRECEIPTS <br />THIS'RECEIPT <br /> <br />$165.00 <br /> $0.00 <br />$165.00 <br /> <br />BALANCE [:)LIE $0.00 <br /> <br /> , ,INVOICE NO: 4449 <br />RECEIVED BY: DM TYPE'.-"IN CHECK ~.+ 0 <br /> <br />SEE ATTACHED DOCUMENT FOR RE(~J'IRENENTS OF ON-SITE'SE~AGE SYSTEM. <br /> <br />NOTc~E.~ T~T[~ DOES NO,._T ¢RANT OR '[NPLY ~SS'I'ON ,TO ;BU,[LD. ON' THTS PARCEL. Pt. AN~IN6 AND <br /> ON P~7,.~ I~.I~T BE ,O~}~AINED BEFORE,~eUILOING OR SEPTIC INSTALLATION BErlINS. <br />PL, R VIEW: BYe___ OI= 'ISOIC=ON: BY °ATE <br /> <br />FORM "M(~ '556 REV ~/67 OFFICE COPY <br /> <br /> <br />