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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 have read and agree to the terms stated on the reverse side of <br /> <br />o,¢.&~rE: 10/04/90 rIME: 9:52:12 <br /> <br /> JACK~:Y,J)N, JOE B. ~ MILDRED <br />SITUS ADDRESS <br /> <br />RE~iDEN f iai <br /> <br /> 8601 HOMQUiSI RD <br /> <br />USE O¢ SUit OING <br /> <br />OR 9'¢825 <br /> <br />SE <br /> <br />CONTRACT CITY UGR OCCUPANT LOAD <br />MARION C~LIN rY NO NO O~ <br /> <br /> PO BOX 118'! <br /> AUMSVI LLE OR 97325 <br /> PHONE:: '149-2227 SIrE NU~ERz <br />lOT BLOCK SECTION TOWNSHIP RAN~LUA r[~:~'-- ZONE <br /> <br />WIDTH DEPTH ARE~ ~ UNITS 8S IRnE& LOT ~ CORNER <br /> <br /> 272 100 27200. SF NO NO <br /> <br />48 <br /> <br />IYPE: ON-Si~E SEWAGE <br /> <br />PbF~U f OR APPLiCAIION NO: <br /> <br />CON ]'RAG IOR. NO. <br />JACKSON, JOE 8. & MILDRED <br />PO BOX 118'7 <br />AUMSViLLE OR 9','325 <br />F~ONE: 749-2227 <br /> <br />902?360 <br /> <br />WA]ER SUPPLY: ~ <br />]~r HOLES READY: <br />Si f'E EVALUAfiON Nur48ER; <br />E~ISFING TANK SIZE: t000 <br />EX~iNG D~IN F~EI_D LINES: <br />MEPFiC I~K PUMPEO: 4-27-86 <br /> <br />5 <br /> <br /> I '! E1¢4 QUAN~ <br /> AUIHORiZAIION NO]ICE - NO ViSiF 1 SB0.0O <br /> <br /> TOTAL A~S~...~z~ED FEES $60.00 <br /> PREVI~ REOEiP,'S ¢ ~ $105.00 <br /> THiS R~EIPT <br /> <br /> PAYEE: JAC~ JOE B. & M~LDREO <br /> ~ECEiVED BY= CL 1YPE: CK CHECK ~: O <br /> <br /> SEE AliACHED ~U~Nf' FOR RE~IREM~[5 OF ON-~iIE <br /> <br />~ THIS IS NOl A PE~ll. 'fills APPLI~TI~ ~ST ~ THB~ A RE~i~ P~ ~ERE THE <br />~OL~iNG ~ST BE ~PLETED. iT IS THE R~SIBiLiTY OF file APPLI~N'f' 1'0 A~URE THAT <br />ALL NEC~ IN~O~TI~ H~ BE~ <br /> <br />PLAN REVIEW: 8Y ~ DAIE <br />REMARKS: AUf'H R'~2906 <br /> <br />OIlY JURISDICTION: BY <br /> <br />UA1 E <br /> <br /> OFFICE COPY <br />FORM # MC 16-66 R~V 4/90 <br /> <br /> <br />