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MARION COUNTY BUILDING INSPECTION <br />SENATORBLDG 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 performmg work on 8 property I own or OCCUpy <br />I am a rog~stered builder OR t ~ the authorized repreaentative SIGNATURE OF APPLICANT <br />of a registered builder <br />The work will be performed by a reg~atered builder <br />Other_ <br />I have read and agree to the terms stated on the reverse side of DATE <br />fbis dooumenf <br /> <br />OWNC.,):A f E .' 05/21/90 T IlVlE: <br />B~TUS ADDRESSHAIvIPf'ON* f'iIV)O'fHY <br /> <br />TAX LOT CATEGORY <br />CONSTRUCTION TYPE OCCUPANCY <br /> <br />RES i DEN f i AL <br /> <br /> 11742 srgiNKA~P RO <br /> AUCF~Vi LLF <br />USE OF BUILDING <br /> <br />OR 97325 <br /> <br />SE <br /> <br />CONTRACT CITY UGB <br />~ARiCN CQUN f'Y NO <br /> <br />OCCUPANT LOAD <br /> <br />LOT <br /> <br />bANE <br /> <br />PHONE.- ?49-2502 SJ, IE NUI'4BER: ?002. <br /> BLOCK SECTION TOWNSHIP RANG'~ALUA'r ION; ZON~ MAP <br /> <br />BEP/H AREA 32 UNITS ~S IRPEO LOT lW CORNER AR 48 <br /> 3.19799995 AC NO NO <br /> <br />TYPE: ON-BIlE SEWAGE <br /> <br />PERMiJ OR APPLiCATiON NO: <br /> <br />O~NIRAC¥OR, NO. <br />HA~PION, FIMOFHY <br />~A~E <br /> <br />PHON~ '749-2502 <br /> <br />9024213 <br /> <br />NAMER 5AJPPLY: ~ <br />TE~.-.~T HOLES READYt <br />Bile EVALUAIlON NUNeER: <br /> <br />.~XI~IING DRAIN ~iELD LINES.- <br />SEPFIC FANK PtJ~PEO: <br />PREVIOUS NO. 8ED~: <br /> <br /> I'f~r4 QUANfI'fY AMOUNI <br /> AUFHORIZAfION NO'lICE - NO VISIT _~"~ 1 SG0.O0 <br /> ~.~O~k~V'fol'AL A~S~EO PEE~ $G0.00 <br /> PREVIO0$ REOEIP"FS $0.00 <br /> THIS RECEIPT SS0.00 <br /> ~-~¢ BALANCE DUE <br /> PAYEE: HAMPION~ I~FHY RECEJPf NO: 2565? <br /> RECEIVED ~Y: mi 'f'Y~E$ CA ~ECK ~: <br /> <br /> ~ AFFACHEO ~C~M~[ FOR RE. IRaqi'S OF ~-S~ f'E SE~GE ~T~. <br /> <br /> THiS I$ NOT A PE~T. ~ A~L~T1~ ~ST ~ TN~ A R~IB P~B ~ERE THE <br />~LL~N6 ~T BE ~ET~+ JT ~ ~E ~JB~L~TY OF TH~ APPLi~T TO <br /> <br />REtCC. RKS: AUYH- NO ViSiT <br /> <br />CiTY JURi$OICFiON; ~¥ OAfE <br /> <br /> OFFICE COPY <br />FORM ~ MO 15-56 REV 4/90 <br /> <br /> <br />