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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 />O~her. <br /> <br />JOHN~N, EARL <br /> <br />TAX LOT CATEGORY <br />CONSTRUCTION TY~E OCCUPANCY <br /> <br />RESiOF-N f l~L <br /> <br /> 8754 M~LL (,;REEK RD <br /> ~uIv~Vl LLE <br />USE OF BUILDING <br /> <br />OR 9'f$25 <br /> <br />SE <br /> <br />CONTRACT CITY UGS <br />'mARiON COUN f Y NO <br /> <br />OCCUPANT LOAD <br /> <br />MAILING ADDRESS <br /> <br />SUSblVlSION <br /> <br />LOT <br /> <br />PHONE: 749-260q <br /> <br /> BLOCK <br /> <br />5ire NUI'4~ER: <br /> VALUAflCYN.~ <br /> <br />ASEA ~'~ UNITS 8~ ISBEG LOT ~ CORNER ~U 5 1 <br /> <br />35. AU NO NO <br /> <br />!YPE.' ON-Si 1E SEWAGE <br /> <br />PEI,¢4I~ DR APPLiCAtiON NO: <br /> <br />(.;ON f SAC FOR, NO <br />JOHNSON, ~RL <br />SAME <br /> <br />PHONE: '!/$q-260 ] <br /> <br />9031550 <br /> <br />WA]ER SUPPLY: pw <br />TEST HOLES READY: <br />SiTE BVALUA~iON NUMBER: <br />E}(iSFiNG ~ANK SIZE: <br />EXISTING DRAIN PiELO LINES; <br /> <br />PREVIOUS NO. 8BBRCOIV~: <br /> <br /> i f El~ QUAN 'l <br /> ANNUAL EVAL_ - FEMP OR H~'~P MH 1 <br /> ~/ TOIAL ~E~ED P~ES $60_00 <br /> ~d ¢ ~ PR~W~5 R~CEIPFS <br /> ~ THiS RECEIPT $60 <br /> <br />  ~NCE <br /> PAYEE; JOHNSON. EARL RECEiP'~ NO: 33329 <br /> RECEIVED ~Y; pp TYPE: CK CHECK ~; 215q <br /> <br /> 5gE Af fACHEO ~O~N~N[ POR RE~iREN~f'5 OF ~-SiFE SEWAGE SYSf'E~. <br /> <br />~ THiS IS NOT A PE~IT. THIS APPLi~TI~ ~ST ~ TH~ A R~i~ P~E~ ~RE THE <br />FOLL~IN6 ~ST BE ~PLETBD. IT IS THE R~SIBILITY OF THE APPLi~T TO ~RE THA~' <br />ALL NEC~RY INFO~TI~ H~ 8E~ P~iDED. <br /> <br /> ~MA~K5= ANNUAL H~RO~HJP RENEWAL <br /> <br />FORM # MC 15,,56 REV 4/90 OFFICE COPY <br /> <br /> <br />