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MARION COUNTY BUILDING INSPECTION <br />SENATOR SLOG NO 225 <br />220 HIGH STREET N~ <br /> SALEM. OREGON 97301 <br /> <br /> PHONE 588-5147 <br /> CODE-A-PHONE 4::30 PM - 8::00 A M <br /> , am perforrning work on a property I own or occupy ~ ._.. _.~ <br /> i am a registered builder OR the authorized representatNo SIGNATURE OF APPLICANT <br /> of a registered builder ' <br /> Tho #ork will be performed by <br /> Other <br /> I have read and ~gree to tho terms stated on the reverse side of SATE <br /> this document <br />DATE: 02/24/89 TIME= 10;08,34a <br />OWNE, LUNDE, GRAHAH TAX LOT 57802--000 <br /> <br />C~,TEeORY RESIDENTIAL <br /> <br /> 7183 SHAW HWY <br />AUNSVI LLE <br /> <br />68O DELF4AR <br />AuMSv I LLE 9?325 <br />PHONE: 749-1790 <br /> <br />bDT BLOCK <br />¢dCTH DEPTH <br /> <br /> CONSTRUCTION TYPE OCCUPANCY <br /> <br /> SE <br />OR 9?325 CONTRACT CITY UGE OCCUPANT LOAD <br /> MARION COUNTY NO <br /> <br /> SITE NUMBER: 6609 <br /> VALUATION: <br /> <br /> 25 8S 2N SA 51 <br />ASEA 1 . 88000 UNITS AC IRREG LOT NO CORm <br /> <br />TYPE';'""'O~-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />LUNDE, GPA,HAM <br />880 DELMAR <br />~JMSVILLE 9?325 <br />PHONE: 749-1790 <br /> <br />9014162 <br /> <br />NATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: 1200 <br />EXISTING BRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROOMS= 2 <br /> <br /> ITEM QUANT I TY AMOUNT <br />AUTHORIZATION NOTICE - FLD. VISIT 1 $105,00 <br /> <br /> TOTAL ASSESSED FEES $105 . 00 <br /> PREVIOUS RECEIPTS $0.00 <br /> THIS RECEIPT $105.00 <br />  E DUE $0.00 <br /> <br />PAYEE: LUNDE, GRAHAM RECEIPT NO: 15004 <br />RECEIVED BY: DM ................... TYPE; OK CHECK ~*: 2513 <br /> <br />SEE ATTACHED OOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br />~< THIS IS NOT A PERf4IT. THIS APPLICATION MUST ~ THROUGH A RE'VIEW PRC~;~ 9tHERE THE <br />FOLLOWIN8 MUST BE COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ~.q,-qURE THAT <br />ALL NF-:OESSARY INFORfCC~TION H~ BEEN PROVIDED. <br /> <br />PLAN REVIEW: 8Y__~/'' DATE_~_/2=_.~__ CITY JURISDICTION, BY ........ DATE ......... <br />REMARKS: AUTH R~7221 <br /> <br />FORM ~f MC 1~5~. REV IU85 OFFICE CC;~P,,,,Y <br /> <br /> <br />