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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 ~m performir~g work on a property f own or oocupy, <br />I am a registered builder OR ( ) the authorized representative SIGNATURE OF APPLICANT; <br />Of a registered builder, <br />The work will be performed by a registered builder. <br />Other <br />I have read and agree to the terms stated on the reverse side of DATE: , <br />this document, <br /> <br /> DATE: 09/29/8"/ <br />OWNER: <br /> <br /> HUSS, EY. A L,/~dq <br />S~TUS ADDHESS: <br /> <br /> 260 ~OTT AVE <br />DETROIT <br /> <br />PHONE: 854.-334,2 <br /> <br />TIME: <br /> <br /> ' <br />TAX gOT: <br /> <br />CONSTRUCTION TYPE: <br /> <br /> ! CONTRACT CITY: i UGB; <br />OR 9?34.2 <br /> <br />i CATEGORYz <br />', ~ <br />', O~CU PANTY: <br /> <br />OCCUPANT LOAD: <br /> <br /> SiTE NUMBER: 2,591 <br /> ! VALUATION: <br /> <br /> '~ 0 i ] ,5 E <br />135 13500.0 , SF,' NO YES <br /> <br />'TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />HUSSEY. ALAN <br /> <br />PHONE: 854-3342 <br /> <br />4,492 <br /> <br />WATER SUPPLY: CW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: PATTON ADDN <br />EXISTING TANK SIZE; <br />E~ISTZNG DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PR~IOUS NO. BEDRO~: 0 <br /> <br /> ITEM QUANTITY AMOUNT <br />STANDARD ON-SITE SYSTEM 1 $125-00 <br /> ~0TAb::AS'SEs~EDFEES $125-00 <br /> ]'BRE"v'I(AJSRECEIPTS $125.00 <br /> ~.ZS, R/CEIPT $0.00 <br /> !EA~0E $0.00 <br /> i voics <br /> NO; <br />PAYEE; <br />RECEIVED BY: DM - ~ ~PE: ~ONECK ~:: <br />SEE ATTACHED DOCUMENT FOR <br /> · : %% :, ,,;,:,: -- ............................ <br />~ THIS IS A VALID PERMIT ~ ~:TS I.Ex,.mUE <br /> DATE. <br /> I,F <br />~¥RUCTION FAI~ TO ~EE'TALI-RE(IUZREMENTS]:~(:N~:iSTAITE!:::i~.~aND"'~"~ I'4ARION COUNTY BUILBINGAND <br />ZONING ORDINANCES. THIS <br /> <br />REMARKS: STANDARD SYSTEM <br /> <br />0CqNALD E. NOODLEY. MARION COUNTY 8UILDZNG OFFICIAL>/ BY <br /> <br />~C.~.M. MC ~5-S6 ~v e/~ OFFICE COPY <br /> <br /> <br />