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¢-~ MARION COUNTY BUILDING INSPECTION <br />· ;'.~'~ SENATOR BLDG. NO. 225 <br />¢~:2 HIGH STREET NE <br />,- SALEM, OREGON 97301 <br /> <br /> ~' pHONE 588-5147 <br /> ,- -.' CODE-A-PHON E 4:30 P.M. - 8:O0 A.M. // V / 'F~// <br /> ) I am a rccgistored builder OR the authorized representetive SIGNATURE OF APPLICANT <br /> of a registered builder, <br /> <br /> Other. <br /> <br /> this document, <br /> DAT~: 04/10/87 TZIV~: 2:09: 51p <br /> OWNER: ~DSE, NO]~%~l~ ' TAX LOY; <br /> <br /> SITUS ADDRESS; CONSTRUCTION TYPE: i OCCUPANCY'· <br /> <br /> 7555 PO~2 RD <br />A~LT,~.. OR 97325 I CC)NTR~ ~i~Y: ~ U~; ~ O00UPANT LOAD: <br /> <br />USE OF BUILDING; N0 0F BEOR00MS: <br /> 3 <br /> <br />MAILIN(~ ADDRESS: } SUSD]ViSi6~; <br /> <br />PO BOX 494 <br />ALRc~rczr.r.R O~ 97325 <br />PBO[~,~: 749-2829 <br /> <br />SITE Nt~EtER: 1045 <br />VALUATION: <br /> <br />LOT: BLOCK: SECTION: ; TOWNSRIP; ' RAN~Ei <br /> 25 8S 2W <br /> <br />WIDTH; 150 DEPTH: 201 AREA; 30150.0 U NR-S: ~ <br /> <br />I~REG. LOT: N CORNER; N <br /> <br />TYPE: ON-SITE S~%~BE <br /> <br />P~RMIT OR A~PLIOATION NO: <br /> <br />CONTRACTOR, NO, <br /> <br />9003519 <br /> <br />WATER SUPPLY: PW <br />TEST ~Ol~S RFADY: <br />SITE EVALUATION <br />5:~ISTIN6 TANK SIZE: <br />E~ISTIN6 DRAIN FI~9',f~ LINES: <br />SEPTIC TANK <br />~OLDIN6 TANK <br /> <br />AFFIDAVIT: <br /> <br />PAYEE: ROSE, <br />R~OEIVED B~: <br /> <br />BEE ATTAC~ED <br /> <br />SP~ ~I~ <br /> <br />~ THIS IS NOT A PE~T. <br /> <br />ALL ~ I~:~RMATiON <br /> <br />QUANTITY <br /> <br />PREVIOUS E~OEIPTS <br />TEIS RECEIPT <br /> <br />AMOUNT <br /> $60.00 <br /> <br /> $60,OO <br /> $O.O0 <br /> $ <br /> $o.oo <br /> <br />2000 <br /> 999 <br /> <br />PROCESS ~ THE <br />~IOANT TO ~ THAT <br /> <br />BY DATE <br /> <br />OFFICE COPY <br /> <br /> <br />