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MARION COUNTY BUILDING INSPECTION <br />SENATOI~t'DLDG. NO. 225 <br />2~0 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 a registered builder OR( ) the authorized representative <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 />06/19/90 'rtNE= 9;05z15 <br /> <br />BALY, ALLEN E, <br /> <br />TAX LOT: CATEGORY: <br />CONSTRUCTION TYPE: OCCtIPANCY: <br /> <br />RESIOEN'f'IAL <br /> <br /> 23861SCHUL'rZ RD NE <br /> AURORA <br />USE OF BUILDING: <br /> <br />OR 97002 <br /> <br />f%~RiON COUNTY NO NO <br /> <br />MAILING ADDRESS .... SUSDIVISION: 2 <br /> <br /> 13023 St~ ~ER RD <br /> PORTLAND, OR 9?219 <br /> PHONE: 539-5351 SITE NUNI~ER~ 8781 <br /> VALUAT if ON: <br />LOT: BLOCK: SECTION: TOWN~HIP: RANGE~ ZONE: MAP: <br /> <br />WIDIH DEPfH: AREA: 32 UNITS: 3,~ IRREG. LOf: 1W CORNER: AR <br /> 1.5: AC NO NO <br /> <br />TYPE: ON-Sil'E SEWAGE <br /> <br />PERf41T OR APPLICA"f'fON NO: <br /> <br />CONTRACTOR, NO. <br />BALY, ALLP-J~ E. <br />13023 T:S!4 RO~ER RD <br />PORTLANB, OR 97219 <br />PHONE: 539-535~ <br /> <br />23576 <br /> <br />NATER SUPPLY: F~ <br />T~'F HOLF_.~ READY: <br />SITE EYALUAI'iON NurflSER: 5-78-7 <br /> <br />EXISTING DRAIN FIELD <br />SEP'[[C T~K <br />PR~Vl~ N0. <br /> <br /> 1'r~1 (.~JANTITY A~OUN'r <br /> STANDARD ON.,,cSi'I'E SYS'rE~ 1 $165.00 <br /> <br /> TOTAL A~ED FE~ ¢165.00 <br /> PR~t~S RECEJPI'S $165_00 <br /> THiS RECEiP'F $0.00 <br /> <br /> PAYEE: RECE~P'f' <br /> RECEIVED BY: PR TYPE: <br /> <br /> SEE A'f'I'ACH~D ~URENT FOR RE~JRE~ENI'S OF ~I'E SE~A~E <br /> <br />~T~CTI~ FAI~ TO ~T IL ~I~8~ OF STATE ~ ~O ~I~ ~NTY BUZZING <br />Z~iN60RBIN~B, THIS PBIT ~ 8BE NULL ~D ~O+ <br /> <br />REt'4ARKS: SEPT'lC <br /> <br />DONALD E. I,~DODLEY, MARION COJN'fY BUILDING OFFICIAL / DY <br /> <br /> OPF[CE COPY <br />FORM ~/M~ ~ §-~$ R~V. 4/~ <br /> <br /> <br />