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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 e property I own or occupy. <br />I am a registered builder OR the authorized representative <br /> of a registered builder, <br />The work will be performed by a registered builder. <br />QtherL <br />I nave read and agree to the terms stated on the reverse side of <br />this document. <br /> <br />TE- 1!/04/87 TIME: <br /> PETERSON & ROBIqAN <br /> <br />2 ~ 44: 55p TAX [.CT: ' CATEGORY: <br /> <br /> 90190-190 <br /> , CONSTRUCTrON TYPE'. ~ OCCUPANCY: <br /> <br />R <br /> <br /> 20923 FILBERT ST <br />,AURORA <br /> <br />USE OF BUILDING: <br /> <br />433 SM 1ST <br />AU RORA <br />PHONE: 266-44'11 <br /> <br />LOT: BLOCK: <br /> <br />WIDTR: DEPTH: <br /> <br />;SECTION: <br /> <br />AREA: <br /> <br /> NO <br /> <br /> SITE NUMBER~ 2936 <br /> VALUATION: <br /> TOWNSHIPz i RANGE: i ZONE; <br /> <br />' .... AS ~ IN ; <br />NO <br /> <br />MAP; <br /> <br />TYPE= ON-SITE SEWAGE <br /> <br />PERHIT OR APPLICATION NO: 5221 <br /> <br />CONTRACTOR, NO. 34084 <br />A. J. BERNDT ENTERPRISES <br />8331 S VALE GARDEN RD <br />CAMAY, ORE 97013 <br /> <br />WATER SUPPLY: C~ <br />TE.ST HOLES READY: <br />SITE EVALUATION NUMBER; <br />EXISTING TANK SIZEt <br />EXISTING BRAIN FIELD LINES: <br />SEPTIC'TANK PUMPED: <br />PREVIOUS NO. 8EDROOI'¢¢S= 3 <br /> <br /> ITEM OUCNNTITY AMOUNT <br />REPAIR $35_00 <br /> <br /> TOTAL AS~ESSED"FEES $35_00 <br /> PREVZOLIS R'ECEI'~TS $35.00 <br /> THIS RECEIPT ~0.OO <br /> <br /> BALANCE DUE $0_00 <br /> <br />PAYEE; INVOICE NO: <br />RECEIVED BY:' CL TMPE: CHECK ~; <br /> <br />SEE ATTACHED DOCUMENT FOR REQUIREMENTS 0,0N-SITE~;SE~AGE SYSTEH. <br /> ~PH~$ ZS A VALID PE~IT $ THIS PEEt4IT-EXPZRES,,.38o'DAY~:FRO~ ITS-ISSUE-DATE"--IF <br />CONSTRUCTION FA~LS TO~EETALL,RE~IRE~ENTSOF;$TATE"'i~5~DNARION COUNTY BUILDING,AND <br />ZONING ORDINANCES, THIS PER~ITSHALb"BE[~3NENULL"ANDVOID; <br /> <br />REMARKS: REPAIR <br /> ¥ <br />DONALD E¢ ~OODLEY, MARION COUNTY BUILDING OFFICIAL / BY <br /> <br />¢0~ = MC ~-Se ~V 6/~ OFFICE COPY <br /> <br /> <br />