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MARION COUNTY BUILDING INSPECT <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 a property I own or occupy <br />lamares~storodbu~derORt )theauthonzedrepresentative <br />of a registered budder <br />The *ork will be per;ormed by a registered builder <br />Other. <br /> <br />BIGNATURB OF APPL <br /> <br /> t)AiE~ f471201~ TIHE~ <br />OWNER TAX LOT <br /> At.. i..EN,, KENNE'IH <br /> <br /> AU~SVILLE rjr 97325 MARION COUNTY <br /> <br />UGB <br /> N0 <br /> <br />OCCUPANCY <br /> <br />OCCUPANT LOAD <br /> <br /> NO OF 8EO~OOM~ <br /> <br />7927 SfONEI;:;]L'LD CI <br />AIJPiSV'[Lt_E OR 97~25 <br />PHONf~: 749"-1860 <br /> <br />SITE NUMBER: <br />VALUA'I" I Ol',l: <br /> <br />LOT BLOCK SECTION TOWNSHIP RANGE ZONE MAP <br /> <br /> 26 88 2W AR. 5] <br /> 0.94 AC NO YES <br /> <br />TYPE: ON-SITE SEWAGE i WAFER SUF'PLY: PW <br /> ', TEST NOLES READY: NO <br />PEE~IT Ot~ APPLICAT'fQN NO: 454~8 f SITE L~VALUATION NUMBER: <br /> <br /> SEPTIC TANK PUMI?,"ED: <br />CONTrACTOr, NO,, <br />At.~; EII~ KEIINETH <br />7~27 STONEFZEL9 CT ' PREVIOUS NO. <br />AUHSVILL. E OR 97325 <br />PHONE= 749'-1868 <br /> <br /> :;[TE~ r X I OUANT] rY <br />SITE EVALUATION, EA. AD,L,,,, LOT~ ~ . , <br /> ~ % % PREVIOUS RECEIPTS <br /> ~¢~%~ tHIS RECEIPT <br /> <br />F'~YEE~ , ~ / R~C, EIPT <br />RESEIVE~ BY: CR .... ~ ................................ TYPE: <br /> <br />,~t:E ATfACI4E~ I)OCUWENT FOR REBU~REHENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br />OFFICE COPY <br /> <br /> <br />