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MARION COUNTY BUILDING INSPECTION <br /> <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 performing work on e property I own or occupy. <br /> lam a registered builder OR( ) the authorized representative <br /> of a registered builder, <br /> The work will be pedormed by a registered builder, <br /> Other <br /> I have read and 8gree ~o the terms stated on the reverse side of <br /> this document. <br /> <br />DATE: 11/05/87 TIMEr 4:21:44p <br />OWNER; <br /> <br />SI f US ADDRESS: <br /> <br /> 13213 8ROOKSIBE DR NE <br /> AURORA <br /> <br />USE OF BUILDING: <br /> <br />SAME <br /> <br />PHONE: 6'78-5414 <br /> <br />CONSTRUCTION TYPE; <br /> <br />OR 97002 iu~: <br /> MARION COUNTY i NO <br /> <br />CATEGORY: <br /> <br />, OCCUPANCY: <br /> <br />;OCCUPANT LOAD: <br /> <br />[ <br /> <br />GRIM ESTATES <br /> <br />2 <br /> <br /> i SITE NUMBER: 3032 <br /> VALUATION: <br /> <br />TS~f6~ ;TOWn'Hi4: <br /> 24 i 45 i 1W ~ EFU <br /> <br />MAP: <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PER~4IT OR APPLICATION NO: <br /> <br />CCAITRACTOR, NO. <br />CHECKAL, JOHN <br />SAME <br /> <br />PHONE: 678-5414 <br /> <br />9005405 <br /> <br />WATER SUPPLY: ON <br />TEST HOLES READY: <br />SITE EVALUATION NUI'48ER; NO RECORD <br />EXISTING TANK SIZE; <br />EX[STZNG DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED; FORM GIVEN <br />PREVIOUS NO. BEDR~: <br /> <br />I TEN QUANT I TY AMOUNT <br />EXISTING SYSTEM EVAL. RPT_ 1 $60,00 <br /> ~'OTAL ASSESSED EEES $60. O0 <br /> PREV IOtJS RECE i PTS $ 0.00 <br /> <br /> :, B,A~CE' DUE' $0.00 <br />PAYEE: CHECKAL, JOHN ,,,, ~RECEIPT NO: 5971 <br />RECEIVED BY: dm ................. , ~ ..... ~.,'~ ~'¥PE'~" CK' CHECK ~: 5266 <br />SEE ATTACHED DOCUMENT FOR EQUIREN,ENTS <br /> <br />ALL N~ IN~Ti~ ~ <br /> <br />P~ REVIEW: BYe_ DATE_ CITY JURISOIC~I~: BY ........ DATE ......... <br />RE~R~: AO~ACY FOR L~ :' ' <br /> <br /> <br />