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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97G01 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: E88-7904 <br /> <br />I am psrforming work on 8 property I own or occupy, <br />lamaregi~"e ed builder OR( ) he au horizedrepresentative <br />of a registered builder, <br />The work will be performed by a registered builder. <br />Other <br />I have read and agree ~o me terms stated on the reverse side ct <br />tills document. <br /> <br />OWNI~Ii~'~' ,~: 09/23/91 <br /> <br /> KO'I'I'RE, RAY <br />SUUS ADDRESS: <br /> <br />CONSTRUCTION TYPE <br /> <br /> 8612 SHAW SQUARE RD <br />AU~.~.VILLE OR <br /> <br />97825 <br /> <br />SE <br /> <br />CONTRACT ,~ TY: UGB <br />MARION COUNTY NO <br /> <br />MAILING ADDRESS: <br /> <br />SLJ SDIVISION <br /> <br />8613 SHAW MARE RD SE <br />AU~VILLE, OR 9'1325 <br />PHONE: 364-2318 <br /> <br />13 8S <br />8.04 AC <br /> <br />~i 'I'E NUIVlB ER.* 1021(5 <br />VALUAT ,[ gN: <br />RANGE ZONE <br /> <br /> 2H AR3 <br /> RREG. LOT CORNER <br /> NO YES <br /> <br />RES 10EN'f' i AL <br /> <br />MAD <br /> <br />TYPE: ON-SI'I'E SE~IAGE <br /> <br />PERMIT OR APPLICATION NO: 34903 <br /> <br />CON'rRAC'f'OR, NO, <br />KOT'FR~, RAY <br />8613 5HA~ SQUARE RD SE <br />AU~VILLE, OR 97326 <br />PHONE: 364-2318 <br /> <br />MATER SUPPLY: <br />TEST HOLP-.~ READY: <br />SITE EVALUATION NUIV~ER: 10216 <br />EXiS'FiNG TANK <br />EXI~'T'ING DRAIN F~LD LINES: <br />SEP'FI¢ TANK <br />PREVIOUS NO~ <br /> <br /> iTEM QUANTITY <br />SE < 6 ~ON'f'HS OLD 1 <br /> <br />'[OTAL~E,..%~EDFEES <br />PREVIOUS RECEIPTS <br /> THIS RECEIPT <br /> <br />BALANCE DUE <br /> <br />AJ'/IOUN'I <br /> $105.00 <br /> <br /> ¢105.00 <br /> 106.00 <br /> SQ-O0 <br /> $0.00 <br /> <br /> PAYEE; RECEIP'F NO: <br /> RECEiVeD BY: cl TYPE: CHECK ~: O <br /> <br /> S~E ATTACHED 00CU~EN'T' ~OR RE. QUJREJ~IENTS OF ON-$iT£ SEWAGE SYSI'E~. <br /> <br />* THI~ IS A VALID PEI;~IT:~ :THIS PEI~iT EXPIRE~ 360 DAY~ FRg~ iTS I,~EAJE DATE. iF <br />CONSTRUCT[ON EAZLS TO r~EET A~LRE(~UIRI~/TS OF~TATE LAh~ AND ~ARION COONTY BUILDING AND <br />ZONING ORDINANCES, THIS PEI~IIT,~-IALLBEC~IViENULLANOVOZD. <br /> <br />REMARKS; NEN SEPIlC R~2581 FOR FUTURE RESIDENCE SII'E <br /> <br />DONALD E, ~OODLE¥, NAR[ON COUNTY BUILDING OFFICIAL / BY <br /> <br />FORM # MC 15-56 REV. 4~0 O F FICE COPY <br /> <br /> <br />