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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 m property I own or occupy. <br />I am a reDistered builder OR the authorized representative <br /> of a reDIstered builder. <br />The work will be performed by a registered builder. <br />Other_~ <br /> <br />ow~'rE: 04123191 <br /> WOODCOCK <br />SITUS ADDRESS: <br /> <br /> T1,ME: 14.'02:01 TXX LOT~ iC~E~ORY; <br />RO~ERI' <br /> <br />RESIDENTIAL <br /> <br /> 13037 MAPLE LEAF C'f' NE i CONTRACT CITY; ( gGg; i OCCUPANT LOAD: <br /> <br /> AURORA OR . <br />USE OF B~ILDIN~: .............. MARtON"~NI'¥~ ~ NO <br /> <br />MAILING ADEIR£SS: ~-- i s0~DivISICN: <br /> <br /> 15560 NH PERIME'rER OR <br /> BEAVERTON, OREGON 97006 <br /> ~E: 629-5633 : S~TE NU~ER: 3170 <br /> I VALUATJ~: <br />LOT:BLOCK: ~ECT~ON; TOWNSH[P: RANG~; ZONE: MAP: <br /> <br />WfDTH: <br /> <br />9 <br /> <br /> 2 , ....... ~.2- ..... 48 1W EF;U 5 <br />DSPTH; AREA: : UNIT~: IRREG LOT: , CORNER: <br /> <br />TYPE: r. JN-S['f'E SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />~JODCOCK , RO~ER'f' <br />15560 NN PERIMETER OR <br />BEAVERI'ON, OREGON 97005 <br />PHONE: 629~5533 <br /> <br />NATERSUPPLY: <br />I'P-~T HOLES READY: <br />SiTE EVALUATION NUMBER: <br />EXiSTiNG TANK ~IZE: <br />EXIS'FING ORAIN FIELD LIN~: <br />SEPTIC 1'~ ~MPED~ <br />PR~I~S NO. BED~: <br /> <br /> ll'~,l <br />~(IS'FiNG ~'FEM EVAL. RPT. <br /> <br />TOTAL AS~EF~SED FEES <br />PREY iOUS :RECEi PTS <br />THIS: RECEIPT <br /> <br />BALANCE DUE <br /> <br />OVANT i l'Y <br /> 1 <br /> <br />PAYEE: RECEiPI' NO; <br />RECEIVED BY: CL TYPE: CHECK <br /> <br />SEE A'F'FAC.~ED ~M~,,l'r FOR REqt~ i RF_..m~B',,I'rS OF ON-S i 'rE SE'Y,~,.~-'i:i SYS'rF.~. <br /> <br />A~4F.J~JN'T' <br /> $100.00 <br /> <br /> ~lO0.O0 <br /> 100.00 <br /> $o.oo <br /> SO.Om <br /> <br /> 0 <br /> 0 <br /> <br /> THIS l~ A VALID PEi~lIT * THI5 ~ITEXPIRE~36013AY~FI~OI~1 ITS I~:~UE [}ATE. IF <br />C~NSTRUCTION FAILS TO ~ ALL R~i~TS~ STA~E ~D~RI~ ~NTY ~ILDING ~D <br />Z~ING O~l~C~. THIS ~[T ~LL 8~NULL~D~lO+ <br /> <br />REMARKS: LOAN REPORT R~5113 <br /> <br />OONALD E. NOODLE¥, MARION COUNTY BUiLDiNG OFFICIAL / BY <br /> <br />FORM # MC 15-58 nEV. 4190 OFFICE COPY <br /> <br /> <br />