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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;30 P,M, - 8:00 A,M, <br /> <br />Iarn performing work on a property I own or occupy· <br />lamaregisteredbu{IderOR( )thesuthorized representatfve <br />of a registered builder, <br />the work will be pedormed by 8 registered builder. <br />Other <br /> <br />I have read and agree to the terms stated on the reverse Side of <br />this document· <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE: <br /> <br /> RUSSELL. <br />SITUS ADDRESS: <br /> <br /> T I ME: 10: 35: 42~ TA× LOT; CATEGORY: <br /> <br />WILBURN 75050-090 <br /> CONSTRUCTION TYPEz OCCUPANCY: <br /> <br />RESIDENTIAL <br /> <br /> 7731 TERRANCE LANE <br /> Ad~SVILLE <br />USE OF BUILDING: <br /> <br />OR 97325 <br /> <br />SE <br /> <br />..... ~RION COUNTY NO NO OF DE~ROOMS <br /> <br />2130 COLE RD S <br />SALEM OR 97306 <br />PHONE: 370-9107 <br /> <br />LOT: BLOCK: i SECTION: <br /> <br /> SUBDIVISION: <br /> <br /> TERRANCE SUBDIVISION <br /> <br /> SITE NUMBER: 8645 <br /> y~A_LUAT I OW: <br />TOWNSHIP; RANG~: ZONE: <br /> <br />WIDTH: <br /> <br /> DEPTH: <br /> <br />137 <br /> <br /> AREA: 2~ UN~TSi 8S I~R~G. LOTZ 2W CORNER: AR <br />234 32058.0 SF NO NO <br /> <br />51 <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: 19697 <br /> <br />CONTRACTOR, NO. <br />PUS. SELL, WIU~URN <br />2130 COLE RD S <br />SALF~ OR 97308 <br />PHONE: 370-9'107 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: WILL CALL <br />SITE EVALUATION NUr48ER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES~ <br />SEPTIC TANK PUNPED~ <br />PREVIOUS NO. <br /> <br /> I TEN (~JANT I TY AtCDUNT <br />SITE EVALUATION, FIRST LOT 1 $175.00 <br /> <br /> TOTAL AS~EO FEES $175.00 <br /> PREVIOUS RECEIPTS $175_ O0 <br /> THIS RECEIPT $0.00 <br /> <br /> BALANCE IDylL $0.00 <br /> <br />PAYEE: RECEIPT NO: <br />RECEIVED BY; c] .......................... TYPE: CHECK ~: <br /> <br />SEE ATTACHED DOCUf4ENT FOR REQUIREt4ENTS OF ON-SIT~ SEWAGE SYSTEffL <br /> <br />NOTE= THIS DOES NOT GRANT OR IMPLY PER~I,%.~ION TO BUILD ON THIS PARCEL. PLANNINO AND <br />CONSTRUCTION PE~IITS ¢4UST BE O~TAINED BEFORE BUILDING OR SEPTIC INSTALLATION BEGINS_ <br /> <br />REMARKS: SITE EVAL. R~6178 SAND FILTER ~ <br />DONALD E. I/¢JODLEY. MARION COUNTY BUILDING OFFICIAL / BY ........................._~,I(?_ <br /> <br />OFFICE COPY <br /> <br /> <br />