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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 performin9 work on a property I own or occupy, <br />~amBregisteredbdilder OR( ) the authorized representative <br />ct ~ registered buitder. <br />The work will be Seffermed by a registered builder· <br />Other <br /> <br /> I have read and agree to the terms stated on the reverse side of <br /> this document· <br /> <br /> DATE: 03/03/88 TIME: 4.* 19:51p <br />OWNER: <br /> ~HMI BTNAN, KIRK <br /> <br />SITUS ADDRESS: <br /> <br /> 12907 MAPLE LEAF CT <br />AURORA OR 97002 <br /> <br />USE OF BUiLDiNG: <br /> <br />TAX LOT: <br /> <br /> CONSTRUCTION TYPE: <br /> <br />CONTRACT CITY; I UGB: <br />~RION COUNTY NO , <br /> <br />MAILING ADDRESS: <br /> <br /> SAME <br /> <br /> PHONE = <br /> <br />LOT: BLOCK: <br /> O3 <br />W~DTH: DEPTH: <br /> <br />IvIAPLE LEAF LAKE <br /> <br />01 <br /> <br />CATEGORY: <br /> RESIDENTIAL <br /> <br /> NO OF ~EDR00MS <br /> <br /> 5 <br /> <br /> SITE NUfVSER: 3780 <br /> i VALUATION: <br />: SECTION: i TOWNSHIP: : RANGE; ' ~0~i iMAP: <br /> 22 i 4S i 1N AR 5 <br />AREA: 1.04,000 jgNITS;, AC I NO i <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PE~4IT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO+ <br />,~M I D~lVlAN, KIRK <br /> <br />6928 <br /> <br />WATER SUPPLY: PN <br />TEST HOLES READY: <br />SITE EVALUATION NUIV~ER: <br />EXISTING TANK SIZE: <br />iD(ISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: ?-21-87 <br />PREVIOUS NO. 8EDROONS: <br /> <br /> ITEM <br />EXISTING SYSTEN E'VAL. RPT. <br /> <br /> ~.TOTAL ASSEsSEDEEES <br /> ' ;!PREV~OUS:::'RECEIPTS <br /> · THI~ RECEIPT' <br /> <br />PAYEE: <br />RECEIVED BY: CL <br /> <br /> QUANT I TY AMOUNT <br /> 1 $60.00 <br /> <br /> ~60.00 <br /> 60.00 <br /> $0,00 <br /> <br /> $0.00 <br />RECEIPT NO; <br />CHECK <br /> <br />SEE ATTACHED DOCUMENT FOR REQUIRE. MENT8 ;OF :ON-SITE SEWAGE ;SYSTEM. <br /> <br />~CTI~ FAI~ TO ~E~ ~D ~RI~ ~N~ BUILDZ~ ~B <br />Z~I~ O~IN~, ~IS PE~IT ~g <br /> <br />REf, IARKS: LOAN R~9155 <br />DONALD E. NOODLEY, MARION COUNTY BUILDING OFFICIAL/BY <br /> <br />FORM ~ MO 15'56 REV ~/87 OFFICE COPY <br /> <br /> <br />