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/ <br />~) I sm performing worx on a property I own or occupy <br /> lamaregisteredbuilderOR( ) the authorized representative <br /> of a registered builder, <br /> The work will bo performed by 8 registered builder. <br /> Other__ <br /> ~ have resd and agree to the terms stated on the reverse side of <br /> this doo~ment, <br /> <br /> DATE: 10/27/88 TIME: <br /> OWNER <br /> COAKLEY. RODNEY & MARIA <br />!'~'IT LJ~ ADD~ES$: ........... <br /> <br />MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 ~IGH STREET NE <br /> SALEM, OREGON 9'7301 <br /> <br /> PHONE 588-5147 <br /> CODE-A-PHONE 4:30 P,M. - 8:00 A.M. <br /> <br /> DATE: <br /> <br /> LOT: I~ CATEGORY: <br /> 56055-000 ~ <br />CONSTROcTION TYPE: i OCCgPANCY: <br /> <br />RESIDEN¢IAL <br /> <br /> 5?85 SHAW HNY ~ ........ i <br /> ! CONTRACT CITY: IUGB'. iOCCUPANT i, OAO; <br /> AUNSVI LLE OR 97325 <br />~ .... ~RION COUNTY NO ; <br /> <br /> MAILING Ag gi=tEgS: sd ~0i~I~iS~;,. 1 <br /> <br />SANE <br /> <br />PHONE= 581-1872 <br /> <br />:LOT: ! BLOCK: <br /> <br /> ~.~.~" i SITE NUNI3ER: 3193 <br /> : VALUATION: <br />',SECTION: !TOWNSH P i RANGE: i ZONE: MAg: <br />: 18 i 8S 1N AR < <br />! AREA ! UNITS; i iRREG. LOT: I CORNER: <br />: 4.9ooooi AC } NO ! NO <br /> <br />TYPE: ON-SITE SEHAGE <br /> <br />PER3~4IT OR APPLICATION NO: <br /> <br />CX:)N T P, ACToR. NO. <br />COAKLEY, RODNEY & <br />SALVE <br /> <br />PHONE: 581-1872 <br /> <br />9012203 <br /> <br />HATER SUPPLY: PN <br />TB~T HOLES READY: <br />SITE EVALUATION NUFSER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: 4-1-88 <br />PRE¥IOUS NO+ BEDROOI'4S: <br /> <br /> ITEM <br />AUTHORIZATION NOTICE - FLD, VISIT <br /> ::, ~:::: TOTAL. ~D:' ~EES <br /> :' :' ' 'I:~RE¥:I~OUS :~RECE I PTS <br /> ;;:' ~J, !8;; REOEI:PT ' <br /> <br />~CE[VEB BY: CL ~PE: OK <br /> <br />(~JANT I TY A~OUNT <br /> 1 $105.00 <br /> <br />RECEIPT NO: <br />CHECK <br /> <br />$105.00 <br />$105.00 <br /> <br />$0.00 <br /> <br />12956 <br /> 3343 <br /> <br />....... C~TY JURISDICTION: 8Y <br /> <br />DATE <br /> <br />~G"M # MC ~-~6 ~EV. ~/~r OFF[CE COPY <br /> <br /> <br />