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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 $88-5147 <br /> <br /> I am a registered b~ilder O~( ) t h~ aut horiz*d reDreser~lative $~NATU~E OY APPLICANT: ~ ~~~ <br /> T~e WOrk will be performed by a registered bwiJder, <br /> <br />DATE: 04/30/90 TIME: 9:41:35 <br /> <br /> F[TZNER, R[CHARD RES[DENTZAL <br /> <br /> 97?3 PORTER RD SE CONTRACT CITY; UGB: OCCUPANT tOAD' <br /> AU~ISVI LLE OR 9*/325 <br /> ~RION COUNTY NO <br /> <br />MA~LING ADDRESS: ~.x'"~'~ ~'. SUBDIVISION: <br /> <br />360 N 11TH -PHIL <br />AUMSVILLE, OR <br />PHONE: 749-2g~5 <br /> <br />WIDTH: DEPTH: AR~A: <br /> <br /> SITE NU~ER: 10027 <br /> VALUATION: <br /> <br /> 9S 1W CPU 60 <br />10, AC NO NO <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: 9023607 <br /> <br />CONTRACTOR. NO, <br />FITZNER. RICHARD <br />360 N 11TH -PHIL <br />AU~VILLE, OR <br />PHONE: 749-2945 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DPJ~IN FIELD LINES: <br />SEPTIC TANK PUMPED: WILL 8RING IN <br />PREVIOUS NO. BEDROONLS: <br /> <br /> ITBVl <br />E×ISTING SYSTEM EVAL. RPT_ <br /> <br /> PAYEE: FITZNER, PHIL <br /> RECEIVED BY: c] <br /> <br /> SEE ATTACHE0 DOCUMENT FOR <br /> <br />~ THIS IS NOT A PER~IT. Ti-ii <br />FOLLOWING I~JST 8E COMPLETED.: <br />ALL NECESSARY INFOI~TION <br /> <br /> RE~ARKS: LOAN <br /> <br /> QUANT I TY AMOUNT <br /> 1 $100, OD <br /> <br /> TOTAL ASSESSED FEES $100.00 <br /> 'PREY{CMS RECEIPTS $0.00 <br /> THIS RECEIPT $100,00 <br /> <br /> 8ALCC4CE DUE $0.00 <br /> <br /> ~ECEI PT NO: 25009 <br /> ............................. TYPE: CK CHECK ~:: 1252 <br />~IENTS OF ON-SITE SEWAGE SYSTEM_ <br /> <br /> GO THROI.16H A REVIEW PROCE~ ~HEI::tE THE <br /> Ri~PONSISILITY OF THE APPLICANT TO /LS,..q~RE THAT <br /> <br />CITY JURISDICTION: BY ........................... DATE ........... <br /> <br />~oa~ ,~ ~c ~-~. ~E'/li/~8 OFFICE COPY <br /> <br /> <br />