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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 8m performifl~g work on a property I own or occupy, <br />lam a registered builder OR ( ) the authorized representative <br />of a registered builder, <br />The work will be per[ormed by a registered builder, <br />Other ........ <br />I have read and agree to the terms stated or~ the reverse side of <br />this document· <br /> <br />olAt~T~: 08/07/8? TIME: <br /> <br /> SALCHENBER6, TON <br />SITUS ADDRESS: <br /> <br />4:01~11p <br /> <br />TAX LOT; <br /> <br />CONSTRUCTION TYPE <br /> <br />CATEGORY <br /> <br />OCCUPANCY <br /> <br />CO~ERICAL <br /> <br /> 5672 VILLAGE VIEW CT SE <br />AUf4SVI LLE OR 9'7325 <br /> <br />OCCUPANT LOAE <br /> <br />~^~L,~ ADO,ESS RESiQ~N~-iAL ~C~RY STRUCTURE8 <br /> <br /> .SAME <br /> <br /> ~ONE: 362-8466 <br /> <br />LOT' BLOCK: SECTION '+OW N SHIP'. <br /> <br />SUBDIVISION: <br /> <br /> '¢-I~LAGE 'V:[ EN <br /> <br /> SITE NUIV~ER: 1823 <br /> .~'~IAT tI::)N: ZONE <br /> <br />WIDTH'20 DEPTH' A~EA '~8 UNIYS 8S <br /> 2.500OO AC <br /> <br />~,~G'. ~OT. 1N co~n AR <br /> NO * NO <br /> <br />49 <br /> <br />TYPE: ON-SITE SENAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />SALCHENBERG, TON <br /> <br />PHONE: 362-8466 <br /> <br />354? <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY.+ <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED= 7-?-86 <br />I:~EVIO~S NO. BED~: 5 <br /> <br /> ITEM QUANTITY At4OUNT <br />AUTHORIZATION NOTICE - FLD. VISIT 1 $65.00 <br /> TOTAL ASSE,'~ED 'FEES $65. O0 <br /> pREVIOUS RECEIPTS $65+ O0 <br /> 71-1:I$' RECEIPT $0. O0 <br /> <br /> SALANOE DUE $0.00 <br /> <br />PAYEE; RECEIPT NO** <br />RECEIVED BY; JE~ .............. ~ TYPE,:, =:,;,CHECK ~: <br />SEE ATTACHED DOCUMENT FOR REQUIRENENTS: OF: ON-SITE ~E SYSTEN. <br /> *,' THIS PERi~I~ iTS 'r~SUE DATE. [F <br />CON~CTION FAII-~ TO O: <br /> <br />REN. AR~; <br />DONALD E. A~3ODLEY, MARION CJ31_INTY BUILDING OFFICIAL / BY <br /> <br />~p,M ~ MC: ~ ~v ~/S~ OFFICE COPY <br /> <br /> <br />