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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 /> <br />I am performir~9 work on a property I own or occupy. <br />iarn a registered builder OR( ) the authoriZed representative <br />of 8 recjistered builder. <br />The work will be perfermed by a registered builder. <br />Other .... <br />I have read and agree to the terms s~ated on the reverse side of <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> DATE; <br /> <br /> DATE: 05/21/90 'f'IME; 11:51:53 <br />OWNER: <br /> E'iTZNER, RICHARD <br /> <br /> 9?73 POR'f'ER RD SE <br />AUM,SV l LLE OR 973,25 <br /> <br />USE OF BUILDING: <br /> <br />CONTRACT CITY: UGB: <br />,feC, R[ON OOUN'i;Y , <br /> <br />MAILING ADDRESS; <br /> <br /> 350 N llTH -PHIL <br /> AUMSV~LLE, OR <br /> / <br /> PHONE: '749-2945 <br /> <br />t eT¸ <br /> <br />W~DTH: <br /> <br /> ' TOWNSHIP: <br /> <br />'IOL <br /> <br />NO <br /> <br />RES [ DEN l I AL <br /> <br /> Si'I'E NUfC, BER: 10027 <br /> VALUA'rJON: <br /> <br />9S ~ 1N EFU 60 <br />AC NO NO <br /> <br />TYPE: ON-SiTE SEWAGE <br /> <br />PEP-J'¢I~'1' OR ARPL1CAf~ON NO: 23607 <br /> <br />CONTRACTOR, NO. <br />FI'f'ZNER, RICHARD <br />360 N 111'H -PHIL <br />AUMSVILLE, OR <br />PRONE: 749-2945 <br /> <br />WATER SUPPLY: <br />TEST HOLE,~ READY: <br />SiTE r,;VALUAI'ION NUTTIER: <br />~[~TiNG 'F~K ~iZE: <br />EXlST~NG D~iN F~ELD LiNES~ <br />SEPTIC 'F~K ~MPEO: WiLL BRING iN <br />PREWI~$ NO. <br /> <br /> I 'FEEl <br />EXiS'T'ING ~YS'T'EM EVAL.. RET. <br /> <br />TOTAL A~SP.g.,%~ED FEE5 <br />PREVIOUS RECEIP1'~ <br />THiS RECEIPT <br /> <br />BALANCE DUE <br /> <br />QUAN'r~'fY AI'4OUN'I' <br /> 1 <br /> <br />$100,00 <br />$100.00 <br /> <br />$0_00 <br /> <br />PAYEE: RECE[R'[ NO: <br />RECEIVED BY: c'l ............................................................................... ~ ............... 'TYPE: CHECK ~: 0 <br /> <br />SEE ATTACHED OC~UMENT FOR REQU~R,5~ENTS OF ON-$Jl'E SEWAGE SYSTEIVl. <br /> <br />* THIS I5 A VALID P~Rt41T ~ THi~ PEI~IIT :EXPIR~ES 360 DAY~ FROI~ ITS ISSUE DATE. iF <br /> <br />REr4,ARKS: LOAN ~ <br />DONALD E. NOODLEY. MARION COUNTY BUiLDiNG OP'E'~C~AL. / BY ......................................................... <br /> <br /> OFFICE COPY <br />FORM # MO 15-56 REV. 4/90 <br /> <br /> <br />