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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 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performing work on a property I own or occupy. <br />I 8m a registered builder OR the authorized regfesentative <br />of a registered builder, <br />The work wilt be performed by a registered builder. <br />Otnor. <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> DATE.* 06/06/91 'riME: 9.-44.-26 <br />OWNER: ~ TAX ~,OT: <br /> GU"f'iERREZ, JOCSE &BEATRiCE i ?5060-050 <br />SITUS ADDRESS: : CONSYRuCTION +YPE; <br /> <br />7821 'I'ERRANCE LN SC= EONfRAOTCIT~: UGe: <br />AUf, t~Vi LLE OR 973¢~5 ' <br /> MARION COUNTY i NO <br />USE OF gUILDINO; <br /> <br /> SAME <br /> <br /> PHONE: 7,49-312;> <br /> <br />LOT: ; BLOCK: <br /> <br /> TOWNSHIP; <br /> <br />26 8S <br />0.88 AC <br /> <br />SiTE NUMBER: 3593 <br />VALUAT i ON: <br />RANGE: ZONE; <br />AR <br />IRREG, LOT: CORNER; <br /> NO NO <br /> <br />CATEGORY: <br /> RES i DEN T i AL <br /> <br />OCCUPANCY: <br /> <br /> 3 <br /> <br />MAP: <br /> <br /> 51 <br /> <br />f'YPEt ON-SiTE SEWAGE <br /> <br />PERMIT OR APPLiCATiON NO: <br /> <br />CONTRACTOR, NO. <br />Gu'rIERREZ, JOSE & BEATRICE <br />SAME <br /> <br />F-'MO~N E: 749-3122 <br /> <br />WATER SUPPLY: <br />'r~'f ROLES READY= <br />SITE EYALUA'FION NUMBER: <br />EXISTING 'rANK SIZE: <br />E%iSTING DRAIN FiELO LINES: <br />SEPTIC 'rANK PUMPED: <br />PRE¥iOU$ NO, BEO~: <br /> <br /> iTEM QUANTITY AMOUNT <br />E~iS'I'ING SY$'TED1EYAL. RPT. 1 $100.09 <br /> <br /> TOTALA~SE~ED?E~S $100.00 <br /> PREVIOUSRECEIP'fS $100.00 <br /> THIS RECEIPT $0.00 <br /> <br /> $o.o0 <br /> <br />BALANCE <br /> <br />PAYEE: RECEIPT NO: <br />RECEIVED BY: CL ....................... ...................................................... TYPE; CHECK ~: 0 <br /> <br /> SEE ATTACHED DOC1J~ENT FOR REQUiREME24TS OF ~.BJ'FE ~E <br />~ THIS l~ A V[tO P~IT * THIS ~'IT ~IR~:360 ~ F~ ITS I~E ~TE. <br />~T~TI~ FAI~ TO ~8 A~ ~I~TS. ~ STATE ~ ~0 ~RI~ ~NTY BUILDING <br />Z~ING OROIN~C~. ~iS ~iT ~A~ B~ NU~ ~O <br /> <br />RF3'4ARK~: NEW SY~'FEM 3/88 / LOAN REPORT R~6439 /'~ ~ <br />DONALD E. NOODLEY, MARION COJN'fY BUiLDiNG OFFJ. CiAL / BY ..................................................................................... ~ <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 REV. 4/90 <br /> <br /> <br />