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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97'301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> I am a registered budder OR the authorized rep esen ave $ GNATURE O¢ APPL CA <br /> of a registered builder. <br /> The work will be Performed by a registered builder. <br /> <br /> I have read and agree to the terms stated on the rever*e s~de of DATE. <br /> th~s document, <br /> <br /> ~'fE: 10/15/90 TIME: 14:50:~ <br />OWNER: TAX LOT: CATEGORY <br /> S'I'~USER, ~RY <br /> <br />  O~~ FERRY RD NE CONTRACT CITY' UGB, OCCUPANT <br /> AU OR 97802 <br /> NO <br /> <br /> VALUA'f i~ <br /> <br /> 4.7 ~ NO NO <br /> <br />RESiDENIiAL <br /> <br />TYPE: DH-Si'rE SEWAGE <br /> <br />PER~4I')' OR APPLICATION NO: <br /> <br />CXJN'rRACI'OR, NO+ <br />S'FRAUSER, IVtARY <br />20500 BOONES FERRY RD NE <br /> <br />PHONEt 6?8-5990 <br /> <br />90~8039 <br /> <br />HATER SUPPLY: P~/ <br />'[E~T HOLEL~ READY: <br />SiTE EYALUATION NUMBER: <br /> <br />EXISTING bRAiN FIELD LiNE~: <br />SEPTIC TANK PUMPEO: 12-21-88 <br />PREViOJS NO. BED~: <br /> <br /> 1 <br /> $1oo.oo <br /> ''~ TOTAL ASSE~EDFE6~ $t00 bO <br /> z~ BREVi Ot~S RECEIPTS' $0;00 <br /> G~ THIS RECEIPT $100.00 <br /> / <br /> BALANCE f:..~E $0.00 <br /> PAYEE= STRAUSER, FIARY RECEIPT NO: 29618 <br /> RECEIVEd BY~ PB .......................................... : ..................................................... TYPE: OK C~ECK =: 446 <br /> SEE AT'rACHEb DOCtJREN'r FOR REQUtREIVlENTS OF ON-SITE $8,~A~E SYSTB',I. <br /> <br />m THiS iS NOT A PER~IT~ THiS APPLICATION I~UST60 THROJGH A REVIE~ PROCEE~ rvCrlERE THE <br />F~LLO~ING tvtdST BE COIVlPLBTED. ITIS THE RESPONSIBILITY OF THE APPLICANT TO ~RE THAT <br />ALL NE~OETSSARY INFORt'¥IATiON HAS BEIii~N PROVIDED. <br /> <br /> BY ................... OITY ..R, biO','ION, .Y ......................... .......................... <br />R,ElvtARKS: EXi~'I'iNG SYSTEIVl EYAL. R'~2992 <br /> <br /> OFFICE COPY <br />FORM # MC 15-SBREV 4/90 <br /> <br /> <br />