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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::39 PM - 8 00 A.M <br /> <br /> 02/27/89 TIME: 12:04;.580 <br /> <br />.,,~lus AOE~SEN, DALLAS <br /> <br /> 9223 9233 W STAYTON RD <br />AUMSViLLE OR <br />USE OF BUILDING <br /> <br />MAILING ~DDRESS <br /> <br />9?325 <br /> <br />SE <br /> <br />SAME <br />PHONE: 749-1089 <br /> LOT BLOCK <br /> <br />2.81000 <br /> <br /> TAX LOT <br /> CONSTRUCTION TYPE <br /> CONTRACT CITY UGB <br />MARION COUNTY NO <br /> SUBDIVISION <br /> <br />SITE NUMBER: 6622 <br /> <br />9S IMREG LOT 2~ OOBNbN EFU <br /> <br />AC NO NO <br /> <br />OCCUPANCY RES I DENT I AL <br /> 2 <br /> <br />TYPE: ON-SITE SENAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />JENSEN, DALLAS <br />SAME <br />PHONE:749-~3089 <br /> <br />9014205 <br /> <br />WATER SUPPLY= PW <br />TEST HOLES READY~ <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: 1000 <br />EXISTING BRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: GIVEN FORM <br />PREVIOUS NO+ BEDROOMS: <br /> <br /> ITEM QUANTITY AMOUNT <br />ANNUAL EVAI~. - TEMP OR HDSHP MH 1 $60.00 <br /> <br /> TOTAL ASSESSED ~EES $60.00 <br /> ~,..~/~/(.~ PREVIOUS RECEIPTS $0.09 <br /> THIS RECEIPT $60-00 <br />  BALANCE DUE <br />PAYEE: REEDE, ELM- RECEIPT NO: 15048 <br />RECEIVED BY: cq ................................ TYPE: CK CHECK ~: 2003 <br /> <br />SEE ATTACHED DOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br />~ THIS ]S NOT A PERMIT. THIS APPLZCAT20N MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO AS,SURE THAT <br />ALL NECES..SARY iNFORMATION HA~ BEEN PROVIDEB. <br /> <br />P ,N REv=*, CITY .RISO,OTION, .......... D TE ............. <br />REMARKS: HDSP AUTH <br /> <br />OFFICE COPY <br /> <br /> <br />