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MARION COUNTY BUILDING INSPECTION <br />S~FNATOR BLDG, NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 RM, - 8:00 A.M. <br /> <br />I am performing work on a roperty I own or occupy. <br />I am a registered bu4der On ( the authorized representative <br />of a registered builder. <br />The work will bo porfomled by a rogistered builder <br />Other <br /> <br />SrGNATURE OF APPLICANT: <br /> <br /> DATE: <br /> <br />D~?: 04/09/90 <br /> <br /> ~qITU ~q Ar~$:HOD4ES <br /> <br />TIME; 10:45:15 <br /> <br />TAX LOT; i dATa'fORT: <br />CONSTRUCTION Ty~449-000 ; OCbDPAN~,~ES I DJ~TIAL <br /> <br /> 14694 KABEL COURT <br />AURORA <br /> USE dP BUILDING: <br /> <br />OR 97002 <br /> <br />NE <br /> <br />AURORA <br /> <br />NO, OF BEDROOMS: <br /> <br />24755 SW 65TH <br />TUALATIN, OR <br />PHONE: 638-8291 <br /> LOT: BLOOK[ <br /> <br />SECTfON: <br /> <br />TOWNSHIP: <br /> <br />SUBDIVISION: <br /> <br />KAZ, EL COURT <br /> <br />SITE NUMBER: 5490 <br />VAM~AT I ON: IONS; <br /> <br />D[PTH~ <br /> <br />AREA: 12 <br /> <br />2. 38000011 <br /> <br />UN'TS: 4S IRREG. LOT1W OORNER~ 1 ~ <br /> AC NO NO <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. 85815 <br />CANBY EXCAVATING <br />122 NE 4TH <br />CANBY, OREGON 97002 <br />PHONE: 266-2?92 <br /> <br />9023061 <br /> <br />WATER .~PPLY: CI <br />TEST HOLES READY; <br />SITE EVALUATION NUD4BER: 11185 <br />EXISTING TANK SIZE: <br />EXISTING BP&IN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROONS: <br /> <br /> IT,EH QUANTI ,TY Ar43JNT <br /> STANDARD ON-SITE SYSTEN $'16;5.oo <br /> <br /> TOTAL ASSESSED FEES $165.00 <br /> PREVIOUS RECEIPTS $O.00 <br /> THIS RECEIPT $165.00 <br /> <br /> BALANCE DUE $0.00 <br /> <br /> PAYEE: CANBY EXCAVATING INVOICE NO: 24451 <br /> RECEIVED SY: PR ......................................................................... TYPE: ,IN CHECK ~:*. 0 <br /> <br /> SEE ATTACHED DOCUHENT FOR REQUIRENENTS OF ON-SITE SEWAGE SYSTEIVI,+ <br /> <br /> ' mis IS NOT A ~IT. mis APPLICATZ0N D~UST <br />F~LL~ZNG ~1UST BE ~.u. IT IS THE RESi;K]~SIBILITY ,OF THE,,APPL'rCANT TO ASSURE THAT <br /> <br />ALL N~RY INFORi~TI(~I HAS BEI~ PROVIDED. <br /> <br /> ........... ..... <br /> REMARKS: NEW SEPTIC INSTALLATION <br /> <br />CITY JURISDICTION~ BY .......................... DATE ............................... <br /> <br />FORMgMC15,$6 REV11/$8 OFFICE COPY <br /> <br /> <br />