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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 <br />CODE-A-PHONE 4;30 P.M. - 8:OO A.M. <br /> <br />lam a registered builderOR( )theautllorlz~d representative <br />The work win be perCormed by a registered builder. <br /> <br />DATE: 11/14/89 TIME: <br /> 8RUSH, CLIFF <br /> <br />90222-430 <br /> <br /> 230 TUMBLE ST ¢ONTR~,C't crrY~ <br />DETROIT OR 97842 <br /> ..... DETROIT .. <br /> <br />MAIUNG ADDRESS; <br /> <br />SUBDIVISION <br /> <br />CLARE A. FITCH - RENTER <br />PO 80× 597, DETROIT 9?842 <br />PHONE: <br /> <br />WIDTH; <br /> 88 <br /> <br /> SITE NUMBER: 4?85 <br /> VALUATION: <br /> <br /> ~ lQ 5E SF <br />DEPTH: AREA: UNfT~: IRREG. LOT: CO~NER: <br /> 100 5000.00 SF NO NC <br /> <br /> RESIDENTIAL <br />OCCUPANCY <br /> <br /> 1 <br /> <br />MAP: <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. 36421 <br />KEVIN'S BACKHOE SERVICE <br />P.O. BOX 465 <br />DETROIT, OREGON 9?342 <br />PHONE; <br /> <br />9020244 <br /> <br />%. <br /> <br />WATER SUPPLY: CN <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROOf'4S: <br /> <br />ITEM (~JANTITY AhlOUNT <br />REPAIR - ~JOR 1 $80.00 <br /> <br />PAYEE: KEVIN'S BACKHOE SERVICE <br /> <br />TOTAL ASSESSED FEES <br />PREVIOOS RECEIPTS <br />THIS RECEIPT <br /> <br />$80.00 <br /> $0.00 <br />$88.00 <br /> <br />BAL.ZC4CE DUE $0.08 <br /> <br />INVOICE NO: 21484 <br /> <br />RECEIVED BY: cl TYPE: tN CHECK St: 0 <br />....................... :-_ ........ % '..___':=-'~:=%_..~ ~=='~'_ <br />SEE ATTACHED DOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEIvL <br /> <br />$ THIs IS NOT A REF~IIT. THIS APPLICATION t'~JST ~O THROU6~ A REVIEW PROOEE~ h~IERE THE <br />FOLLOWING I~U,~T BE COfflPLETED. IT I$ THE RESPONS'fBiLITY OF THE APPLICANT TO ~RE THAT <br />ALL NECESSARY INFORNATION HAS BEEN PROVIDEB. <br /> <br />REMARKS: MAJOR REPAIR <br /> <br />CITY JURISDICTION: BY ....... DATE <br /> <br />OFFICE COPY <br /> <br /> <br />