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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG NO 225 <br /> , 220 H~IGH 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 />The work will be performed b'y a registered builder <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br />ow~J' E: 12/1 T/90 'rIME= <br /> <br /> EDMERY, ADRIAN <br />SITUS ADDRESS <br /> <br />17~48~50 <br /> <br />TAX LOT CATEGORY <br />66952~000 <br /> <br />RESIDEN IiAL <br /> <br /> 435 NOR'rH SAN'tlAM HWY <br /> DEfROi! OR <br /> <br />USE OF BUILDING <br /> <br />97342 <br /> <br />uas <br /> <br />"CONTRACT CITY OCCUPANT LOAD <br />O~IRI]i1 NO <br /> <br />MAILING ADDHESS ...... SUBDIVISION <br /> <br />5717 14tH AVE <br />KEIZER OR 9?303 <br />PHONE: 390-1137 <br /> <br />LOT BLOCK SECTION <br /> <br />TOWNSHIP <br /> <br />SI~tALL la,NE I'RACi ~10 <br /> <br />SiTE NURSER.-- 11830 <br />VALUA r ION: <br /> <br />13 3 01 10 5E REJ <br /> YES NO <br /> <br />FYPE: (,~-SITE SE-NAGE <br /> <br />PERMIT OR APPLIOAFION NO-: 29057 <br /> <br />CONIRACrOR, NO. <br />EMERY, ADRIAN <br />5717 14'fH AVE <br />KEIZER OR 97303 <br />PHONE: 390-1137 <br /> <br />WATER~CJPPLY: <br />TEST HOLES READY: WILL CALL <br />SITE b~AIJUAI"iON NU/VlBER: <br />EXlS[ING TANK SIZE; <br />EXiSTiNG DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PRE¥IOUS NO. BEDROOm: <br /> <br /> QUAN'rIrY <br />8iTE EYALUAFION, FIRsr LOT 1 $175.00 <br /> <br /> TOTAL A.~E....~SED FEES $175,00 <br /> PRE~i~S RECEIPT8 $175,00 <br /> THIS RECEIPT $0.O0 <br /> <br />PAYEE: <br />RECEIVED <br /> <br />BALANCE <br /> <br />INVOICE NO: <br />C~ECK ~: 0 <br /> <br /> TYPE <br /> '~"' '-'-T ........................... ~ <br />SEE Al fACHbD DOCUMISNT FOR Rr::3QUIRE~ENfS OF ON-SiTE ,~E~E SYE~TEM. <br /> <br />NOTE: THIS DO~E~ NOT GRANT OR IMPLY I:>ERI~iI,?:~ION TO BUILD ON THIS PARCEL. PLANNING AND <br />CONSTRUCTION PERM/TS IV~T BE O~TAINED BEFORE EIUILDING OR SEPTIC INSTALLATION BE~iNS, <br /> <br />REMARF,.S: 5E - SEEPAGE 'FRE. NCH hA <br />DONALD E. WOOOLEY, ~RION ,r...tO~Nfy BUILDING OFFICIAL / DY ..................................................~ <br /> <br />OFFICE COPY <br /> <br /> <br />