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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 92,5 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 P,M. - 8:00 A,M, <br /> <br />I am gerformlng work on a property I own or Occupy, <br />I am a registered builder OR( )thesuthorized representative <br />of a registered builder, <br />The work will be performed by a registered builder, <br />Other <br />F have rc..~'d~'~nd agree to the terms stated on the reverse side of <br />this document <br /> <br />DATE: <br /> <br /> F(AYMON D/LEJkGYELDS , 68960-000 R~'~B i DEN T [ AL <br /> <br /> 400 DETROIT RD F-bS~"Si~; ~'0~: OCCUPANT LOAD: <br />DETROIT <br /> 342 <br /> <br />' F_ DEAN JASPERS - BUYER <br /> 2192 SO HILLCREST DR WEST LINN <br /> PHONE: 636-2936 <br /> <br />LOT: iSLOCK: <br /> <br />103 i <br /> <br /> SITE NUMBER: 5355 <br /> VALUATION: <br /> iSECTIO~: TOWNSHIP: ~NGE; , ZONE: i MAP; <br /> <br /> I 10 5E <br /> <br />89 SF YES i NO <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PEFC4IT OR APPLICATION NO: 10831 <br /> <br />CONTRACTOR, NO. <br />PC, YMOND/LE. AGYELDS <br />F_ DEAN J~PERS - BUYER <br />2192 SO HILLCREST DR WEST LIMN <br />PHONE: 636-2936 <br /> <br />WATER SUPPLY: CW <br />TEST HOLES READY: YES <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED~ <br />PREVIOUS NO. BEDROOHS: <br /> <br /> ITEM QUANTITY AMOUNT <br />SITE EVALUATION, FIRST LOT $175.00 <br /> <br />.TOTAL ASSESSEDFEES <br />PREVIOUS.RECEIPTS <br />THIS RECEIP- <br /> <br />175+00 <br />$0.00 <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE~ INVOICE NO: <br />RECEIVED BY: C] TYPE: CHECK <br /> <br />BEE ATTACHED DOCUMENT FOR REQUIREMENTS OF ON-S,ITE SEWAGE SYSTEM. <br /> <br />NOTE: THIS DOES NOT GRANT OR IMPLY PERMISSION TO BUILD ON TH,IS PARCEL. PLANNING AND <br />CONSTRUCTION PERMITS MUST BE OBTAINED BEFORE 'BUILDING OR SEPTIC INSTALLATION BEGINS. <br /> <br />REMARKS: BITE EVAI_ <br />00NAL0 E- WOODLEY, 1'4ARION COUNTY BUILDING OFF['CiAL"> BY <br /> <br />o~u ~ M~; ~,~.e ,~v ~/s~ OFFICE COPY <br /> <br /> <br />