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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 />lam performing work on a p~'oper'ty I o,~n or occupy, ~~ ~ ~...~,.~ <br /> <br />OW~b~t~: 86/12/90 liNE: 11:09:56 <br /> <br /> WBLLS. JEFFERY <br />S~TUS ADDRESS <br /> <br />TAX LOT CATEGORY <br />CONSTRUCTION TYPE OCCUPANCY <br /> <br /> ]2173 WES[ SIAYfON RD <br /> AU fc6V i LLE OR <br />USE OF BUILDING <br /> <br />9'7325 <br /> <br />CONTRACT CITY UGB OCCUPANT LOAD <br />MAR,!,L,~ COUNt Y NO <br /> <br /> PHONE¢ 789-'7388 SiIE NUMBER: 10414 <br /> VALUATION: <br />t. OTRt. OCK SECIlON TOWNSHIP RANGE ZONb MAP <br /> <br />WIDTH DFPTH ARSA UNITS IRREG LOT CORNED <br /> 4.87999983 AC NO NC) <br /> <br />TYPE: 0N-5iI~ SEWAGE <br /> <br />PERIVltT OR APPLICATION NO: <br /> <br />f,X,)NfRACIOR, NO. <br />WELLS, JEFFERY <br /> <br />9024788 <br /> <br />WATER SUPPLY: ~ <br />rEST HOLES READY: <br />SiI~ ~VALUAIiON NUIV~ER: <br />EXtSFiNG FANK SIZE: <br />EXlSIING ORAIN FIELD LINES: <br />SEPTIC FANK PU~PEO: <br />PREVIOUS NO- BEDROOf4~: <br /> <br /> ~T~M QUANTiIY AMOUN1 <br /> REPAIR ~ MAJOR 1 $80 00 <br /> <br /> lO1AL A~E~ED PBE~ $80.00 <br /> PREWIOUS RECEiP'¥8 $0,00 <br /> 'lHI~ RECEtP~ <br /> <br /> BALANCE f,)U~ $0_00 <br /> PAYEE: NELL5. ,J~PPERY RECEIPT NO: 26243 <br /> RECEIVED BY: CL TYPE: CK CHECK ~: ~'!50 <br /> <br /> SB~ A[ fACHED OOC~NENf' FOR REQUiREJ~4E'NIS OF ON-SIrE SEWAGE <br /> <br />* THiS IS NO~ A PERI',q~T. THIS APPL~OATJ0N I~UST GO THR(;t.16tt A R'~/IE~ PROCES~ ~I£RE THE <br />FOLLOWING 1'4UST BE 6Of,IPLETED. iT 15 THE RESPONSiBiLITY OF THE APPLIC$~T TO ~R~ THAT <br />ALL NECESSARY INFOR~qA¥iON H,A~ BE~I <br /> <br />PLAN RgVlb'W~ 8Y ~J... <br />REMARKS: MAJOR REPAIR <br /> <br />CITY JURiSOiCfION: BY DAFE <br /> <br />OFFICECOPY <br /> <br /> <br />