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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STR~'ET 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 performin¢¢ work on a propesty I own or occupy. <br /> I am a registered builder OR ( ) the authorized representative <br /> of a regis ered builder, <br /> The work will be performed by a regL'~tered builder. <br /> Other <br /> <br /> DATE: 09/13/88 TIME~ <br />:OWNER: <br /> STEELE <br />SIfUS ADDRESS: <br /> <br />13132 BROOKSIDE DR <br /> <br /> 71580-130 <br />CONSTRUbY~O~ TVP~: <br /> <br />; CAT~GORY; <br /> REST DENTIAL <br />i occu~'x~cY: <br /> <br /> AURORA <br />'US~- OF B0~D~NG: <br /> <br />2495 N W k~ODERE~T <br />ALBANY. OR 97321 <br />PHONE: 928-5018 <br /> <br /> 518 2 <br />WtDTJ.J: ;DEPTH: <br /> <br />172 118 20296.0 <br /> <br />TYPE: ON-SITE SENAGE <br /> <br />PERMIT OR APPLICATION NO: 9011096 <br /> <br />CONTRACTOR, NO. <br />STEELE <br />2495 N ~ ~,¢~ODEREST <br />ALBANY, OR 97321 <br />PHONE: 928-5018 <br /> <br /> SF NO i NO <br /> <br />WATER SUPPLY: ON <br />TEST HOLES READY*. <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE; 1000 <br />EXISTING DF~IN FIELD LINE~: <br />SEPTIC TANK PUMPED: 9-12-88 <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM _r~ QUANTITY AMOUNT <br />EXISTING SYSTEM EVAL.. RPT. (,~.~(.~>"~_. 1 $100.00 <br /> ..?,.~¢_~ TOTAL AssESSE0 FEES $10 O. Oo <br /> ,,~ PREVIOUS RECEIPTS $0.00 <br /> '~ THIS RECEIPT . ' $100.00 <br /> <br /> ¢ALANCE DUE $0.00 <br />PAYEE.- RONALO DOOKTER-PURCHASER /"~ ~ RECEIPT NO.- 11812 <br /> <br />SEE ATTACHED DOCUMENT FOR REQU:IRI~,IENTS OF ON:zSITE ~EE.sYSTB'tl. <br />* THIS IS NOT A PERMIT. THIS APPLICATION MUST A RE~IEIN PROCEE~ ~ERE ]HE <br />FOLLOWING MUST 8E COMPLETED. IT IS THE RESP~I8ILITY OF: TH~ APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFO~TION HAS SEEN PROVIDED~ <br /> <br />PLAN REVIEW; eY DATE' ' CZTY~JO~ISDIET~ON; 8Y ~ DA'rE <br />REK~ARKS: ESR FOR LOAN P~482S <br /> <br />FORM ,, MC ~.r.<~ .~v e/~7 OFFICE COPY <br /> <br /> <br />