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SENATOR BLDG. NO, 225 <br />220 HIGH STREET NE <br />SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8;00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />Ct a registered buitder, <br />The work wilt be perfformed by a registered builder, <br />Other <br /> <br />SIGNATURE OF APPLICANT; <br /> DATE'. <br /> <br />OWNed'rE= 05/22/91 'rIME= <br /> BRYAN I, AXJNALD ~_ <br />SWUS ADDRESS <br /> <br /> 14812 SOB'S AVE <br /> AURORA <br /> <br />USE OF BUILDING; <br /> <br />OR 97002 <br /> <br /> CONTRACT CITY' <br /> <br />AURORA <br /> <br /> SAME <br /> PHONE: 6'18-1065 <br />LOT:BLOCK~ <br /> <br />WIDTH; DEPTH: AREA UNITS: <br /> <br />UGB: <br /> <br /> NO <br /> <br />SITE NUMBER: <br /> VALUA I 1 (AN: <br />RANGE <br /> <br />CATEGOFI' <br /> RESI DEN'i IAL <br />OCCUPANCY <br /> <br />ZONE; MA~ <br /> <br />CORNER <br /> <br /> N(.) <br /> <br />TYPE; ON-SJ,'I'E SEINAGE <br /> <br />PERMf'f' OR APPLiCATiON <br /> <br />CONTRAC'f'OR. NO. <br />BRYANT', RONALD N. <br />S/~4E <br /> <br />PHONE: 678-1088 <br /> <br />31 ?83 <br /> <br />WATER ~;~JPPLY: <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXIS'f'JiNG DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. <br /> <br /> 11'EM QUANT i 'f'Y ANOUN <br /> EXiSTiNG SYS'fFJ~4 EVAL. RP'f'. 1 $100.00 <br /> I'O~AL ASSE'SSED FEES $100- 00 <br /> PREVtQUS RECEIPTS $100.00 <br /> 'rHZS R CEZPT oo <br /> <br /> PAYEE: , iNVOiCE NO: <br /> R~CEiVEB BY: CL ........................... ::._ ........... ;, .................... TYPE; CHECK ~: 0 <br /> <br /> SEE ATTACHED ~UNBN'r FOR RE~R~'rS OF ON-S~TE SEWAGE <br /> <br />* THI~ ~ A VALID PE~IT TH~8 P~T ~P~ 360 ~ ~ iTS [~E <br />~ST~OTI~ FAJ~ TO ~T ALL R~I~T~ OF STATE ~D ~R~ ~NTY <br />Z~ING ORDi~C~, THIS P~IT ~B~ NU~ ~O <br /> <br />REMARKS: LOAN REPORT R~5145 <br /> <br />DONALD g. ~¢OODLEY, MARION COUNTY BUiLDiNG OFFiCiAL / 8Y <br /> <br />OFFICE COPY <br /> <br /> <br />