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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> I am performmf~workor~a ropertylown or occupy. <br /> larharegister~dbudderOR( )theau~honzedrepresentative <br /> of a reglsterod builder, <br /> The work will be per[ormed by a registered builder. <br /> Other <br /> I have read and agree to the terms stated on tho rovorse Side of <br /> <br />0A'~: 09/05/91 f'J~: 1~:29:41 <br />OWNER <br /> KOI ~R~, RAY <br />SmTuS ADDRESS <br /> <br /> PHONE: 888-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />DATEz <br /> <br />TAX LOT <br /> <br />CONSTRUCTION TYPE <br /> <br />CATEGORY <br /> <br />OCCUPANCY <br /> <br /> 8612 SHAW ~..~UAR~ RD <br />ALJMSVILLE n~ <br /> <br />USb O¢ BUILDING: <br /> <br />SE CONTRADT OIYY: UGB] <br /> MARION COUNTY Nr) <br /> <br />ODCUPAN9 LOA[ <br /> <br />86t3 SHAW SQUARE RD ~: <br />AUMSVILLE, OR 97325 <br />PHONE: 364,~2318 <br /> <br />LOT' BLOCK SEC'flOr, <br />W~OTH DEPTH. AREA: <br /> <br /> TOWNSHIP' <br /> <br />6.04 AC <br /> <br /> VALUATION: <br /> <br />RREG. LOT' CORNER <br /> N(.) YES <br /> <br />RESI©EN~iAL <br /> <br />MAp¸ <br /> <br />'fYPE: ON-SL/'E SEWAGE <br /> <br />PERMI/ OR ,APPL/CAIION NC): 9034903 <br /> <br />CON1 RACI OR, NO. <br />KO[ f'RE, RAY <br />8613 BHAN S(ggARg RD SE <br />AUMSVILLP,, ¢)R 9?325 <br />F;'I"ION~:: 3~4-23] 8 <br /> <br />WATER SUPPLY; PW <br />TESF HOLES READY: <br />SIf'E EVALUATION NUMBER: IN PROCESS <br />P.,.~ISf'iNG 'lANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />5EP'FIC TANK PUMPED: <br />PREVIOUS NO. BEDROOm5; <br /> <br /> I. 'f'EM QUANT 1 'T'Y AMOUN'f <br />SE < 6 MDNIH5 OLD '] $]05_06) <br /> <br /> TOTALASS~EO FEES <br /> PREVIOUS RP. AgEIPI'S $0,00 <br /> THIS RECEIPT <br /> <br /> BALANCE ,C~,,IE $9.00 <br /> PAYEE: KC)fIRE RAY ~ RECEIPT NO: 36874 <br /> RECEIVED ~Y: P8 ~} "YPE; CK CHECK ~: 879 <br /> <br /> SEE A[fACHED OOCU~ENT FOR REQUJRENENTS OF ON~'f'E SEWAGE SYSTEM. <br /> <br />* THiS IS NOT A PE~iT. THIS APPLICATION fcUST GO THI~EtJGH A RE~lEl~ PROCE~SS ~ERE ?'HE <br />~OLLO~/ING f4UST BE C~f~PLETEO. IT [5 THERESPONSIB[LiTY OF THE APPLICANT TO ASSURE THAT <br />,ALL NFJC~55ARY iNFO~4AT/ON HASBE~ PROVIOED. <br /> <br />PLAN REVIP~W: BY DATE Ci[Y JURi~DI(JTION: BY <br />R~MARKS: NEW '.SEP[ lC Rq:;_)581 <br /> <br />DAlE <br /> <br />FORM # MC 15-56 REV. 4/90 OFFICE COPY <br /> <br /> <br />