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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO 225 <br />2.20 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 />SIGNATURE OF APPLICANT <br /> DATE <br /> <br />ow~li~rlE.. 01/09,/91 =liNE: 14=37:18 <br /> <br /> HER~NN, ~Y <br />S~TUS AOORESS <br /> <br />RE~i DEN riAL <br /> <br /> 9273 ,~AW S~UARE RD <br /> AUf~Vl LLE OR <br />USE OF BUILDING <br /> <br />97325 <br /> <br />CONTRACT CITY UGB OCCUPANT LOAD <br /> <br />5+ <br /> <br /> SiYE NUI~BER: 11610 <br /> YALUAT iON:~p <br /> <br />UN~TS ~'~' IRREG LOT 2W CORNER AR3 49 <br /> AC NO NO <br /> <br />tYPE: ON-S[1E SEWAGE <br /> <br />PE,ql~')l~ OR APPLiCAIiON NO-* 29999 <br /> <br />OON rRAC foR, NO. <br />H ERF,~'~N, ROY <br />DF_.,.%IREE HERR~4ANN - NOBiLE OMNER <br />9254 ~HAW S~UARE RO 8E AU~ViLL <br />~E: 364-1233 <br /> <br />!NATER SUPPLY: <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />I~XISTIN~ TANK SIZE: <br />~ISTING O~iN F'IELD LiNE~: <br />SEPTIC 'r~K ~PED: 1-3-91 <br /> <br /> ! r EM r-.,,t J AN T i TY AMOUNr <br />AUIHORiZAlIE.~ NOTICE - FLD. ViSZ1 1 $105.00 <br /> <br />PAYEE: <br /> <br />TOTAL ASSEm, SSED FEES <br />PrEvious RECEiP1S <br />FHIS RECEiPf <br /> <br />¢105.00 <br />105.00 <br /> $o.oo <br /> <br />BALANCE <br /> <br /> RECEIPT NO: <br /> TYPE: CHECK ~: <br /> <br /> SEE AIlAC~ED DOCUMENT FOR REQUIREI~IENTS OF ON-SiTE SEWAGE SYS1F.~I. <br /> <br />* THIS [8 A VALID PER~[T * THIS PERI, iT EXPIRES 960 DAYS FRO~ IT8 ]88UE DATE. <br />CONSTRUCT/ON FAII.~ TO MEET AU_ RISi~UIRENENT$ OF STATE LA!N~ AND MARION COUNTY BUILDIN~ <br />ZONIN~ ORDINalS. YMI$ P~I~IT 8HALL ~F. CO~ NULL AND VOID. <br /> <br />REf4ARKS: SEPTIC AU1H - HARDSHIP R~3447 <br /> <br />0ONALD E. WCODLE¥. fVlARiON COUNTY BUILDING OFFICtAL/ BY <br /> <br />FORM # MC ~5,56 REV 4/~0 OF FICE COPY <br /> <br /> <br />