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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: 580-514.7 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performing wot,k on a property t own or oocupy. <br />I am a registered builder OR ( / the authorized representative <br />of a registered builder, <br />The work will be pet'forrfled by a regirtered builder, <br />Other <br /> <br />01/22/91 TIME: <br /> <br />situs ADDH~$~¢B'BL' FF'JSERI' <br /> <br /> 5922 VILLAGE VlE]H COURT <br /> AUf4SVI LLE OR 9?325 <br />USE Of- IJUILDING: <br /> <br />SE <br /> <br />CONTRACT CrTY: UGB: <br />t~ARION COUNTY L NO <br /> <br />RESI DENT iAL <br /> <br />2 <br /> <br /> PO BOX 1457 <br /> CEDAR CITY, UTAH 94?20 <br /> PHONE: 801-586-8081 <br /> <br />LOT: 8LOCK: <br /> <br /> VILL~EViEW <br /> <br />SITE NUIV~ER: 9985 <br />R~N~LUA'rlON:;zoN~: <br /> <br /> IRREG, LOT: CORNER; <br />~ NO NO <br /> <br />'IYPE~ ON--si'rE SEWAGE <br /> <br />PERMi'r OR APPLICATION NO: 23512 <br /> <br />~ONTPC, C'fOR, NO. <br />BAHL, ROeER'I' <br />PO BOX 1457 <br />CEDAR CITY, u'rAH 94720 <br />PHONE: 801-586-8081 <br /> <br />HATER SUPPLY: PN <br />TF.qT HOLES READY: <br />SITE E~/ALUATION NUMBER: <br />EXISI'IN6 TANK SIZE: 1000 <br />~7XiSTIN8 D~JN FiELO LiN~: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROOMS: UNKN(~4N <br /> <br />~.50 <br /> <br /> l I'E'~I <br />AUTHORIZATION NOTICE - FLD. ViSiT <br /> <br />TOTAL A,.~SB~.~ED FEES <br />'PREVIOUS,RECEIPTS <br />THiS RECEIPT <br /> <br />BALANCE DUE <br /> <br />(;~ANTII'Y AMOUNT <br /> $105.00 <br /> <br /> ~105.00 <br /> 105,00 <br /> $o.oo <br /> <br />TYPE: 0 <br /> <br />RECK[PT NO,; <br /> CHECK <br /> <br />PAYEE: <br />RECEIVED BY: CL <br /> <br />SEE ATTACHED DOCUM~N'F FOR REOUIRE~IENT8 OF ON-si'rE SE~GE SY3TE~I. <br />THI~ IS NOT A PE~ZT <br /> <br />$0.00 <br /> <br />RF_~ARKS: REPUNO OF UN-i~EO APPLICATION <br /> <br />DONALD E. NOOOLEY, RARION COUNTY BUILDING OF'FICIAL / BY <br /> <br />~o~ ~ uo * ~-~ REV..ko OF FICE COPY <br /> <br /> <br />