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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 8:00 - 4:30 <br />24. HOUR CODE-A-PHONE:: 588-7904 <br /> <br />I am performing work on a property I own or oocup~ <br /> <br />L)AI~: 09/1/,/91 'II, M~: ~2:28:39 <br />(~R[)NER, SfEVEN & CARLA <br /> <br />SIGNATURE OF APPLICANT <br /> <br /> DATE <br /> <br /> TAX LOT <br /> <br /> CONSTRUCTION tYPE <br /> <br />CATEGORY <br /> <br />DEN l <br /> <br />~,UMbV 1 LLb OR <br /> <br />USE OF BUILDENG <br /> <br />MAILING ADDRESS <br /> <br />5b <br /> <br />CONTRACT CITY UGB <br />MARION COUNTY NO <br /> <br />SUBDIVISION <br /> <br />OCCUPANT LOAD <br /> <br /> NO 0~ B£DR00MS <br /> <br /> PHONE: 1AS-;¢462 <br /> <br />LOT 8LOCK SECTION I OWNSH I P <br /> <br /> b- <br /> <br /> 5I l~ NUFID~R: 59!~2 <br /> VALU~I~ON: <br /> <br /> RANGE ZONE <br />~5 2W <br /> IRBEG lOT CORNER <br />AC NO NO <br /> <br />MAp <br /> <br />T Y!'~(;: 0N"'5 J. 1 E SEWAGE <br /> <br />/'>LRMIf (.iR APPLICATION NO: <br /> <br />CON f RAC fOR, NO. <br />r,¢ARONEI'~, ELEVEN & CARLA <br /> <br />PHC)NE: /4 9--24!52 <br /> <br />~A~R ~UPPLY: <br />f~Si HOLi' ~"ADY: <br />511g EVALUAf[ON NUMBER: <br />EXISFiNG lANK <br />~Xt~ING DRAIN FIELD <br />SEPTIC TANK PUMP~U: <br />PREV[0US NO. ~EDROO~G: <br /> <br /> ITEM OUANIITY A~UNi <br />AUfH£)RIZAtlON NOTICE -- NO VISIf 1 $50_0o <br /> <br /> T0~AL AESE~ED P~5 <br /> PREWIOU~ RECEiPY5 SbO O0 <br /> ~HiS R~C~iP1 <br /> <br />t'~ALANC~ 0UE $(J. 0I~ <br /> <br /> PAYkb RECEIP] NO: <br /> RECEIVED dY- cl fYPg: CHECK a: 0 <br /> <br /> SEE ,AT [ACHED DOCUMENT P£}R R~QUIREMENfS DP ON~5i fE ~AG~ ~YSI EM_ <br /> <br />~ THiS IS A VALID PER~iT * THiS PER~IT EXPIRES 360 DAYS PROM [TS ISSUE DATE. IF <br />CONST~JCTIGN FAIL~ 10 ~EET ALL RE~I~TS OF STATE <br />Z~iNG ORDiN~C~, 1HI~ P~i~ ~ALL BEdE NULL ~D <br /> <br />N~MARKS- AUlH R~3264 <br /> <br />IX;NAIl.) l:. NOODLEY, ~IARiON COUNTY BUILOtNG OPPI(2!AL. / 8Y <br /> <br />OFFICE COPY <br /> <br /> <br />