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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 performing work on a Oroperty I own or occupy. <br />I am a registered builder OR tile authorized representative <br />of a registered builder. <br />The work wilt be performed by 8 registered builder. <br />Other <br /> <br />°w~f'E; 09/11/90 TIME: 10:30:50 TAX LOT: CATEGORY: <br />SITUS ^BORE~:I LLiCAN, BiLL CGNSTRI,JCTJON TYPE: OCCUPANCY: <br /> <br />RESiDENTiAL <br /> <br /> ]15 BU'f'f'E S'f -- <br />u s d2~'~: f'~:~.,~'I~ G: OR 9?,34,2 <br /> DE'TROi T NO NO OF ~rrmo0M~ <br /> <br /> P.O. BOX <br /> OE'rROlf, OR 97~42 <br /> <br />LOT: : BLOCK: <br /> <br /> SITE NUD1BER; 11178 <br />i$~CTION: TOWN'NIP: BANCC~LUA'f'ION: ZONE: MAP: <br /> <br />WIDTII: DEPTH: AREA~ '1 UNITS: <br /> <br />10 IRREG LOT: 5E CORNER. R~5 <br />Sf NO ........ NO <br /> <br />TYPE: ON-Si'rE SEWAGE <br /> <br />PERMIT' OR APPLICATION NO: 9027128 <br /> <br />CON'rRACf'OR, NO. <br />~iLLiCAN, BiLL <br />P,O. BOX 484 <br />OE?ROJT, OR 9?342 <br />PHONE: 854~3626 <br /> <br />WATER SUPPLY: CN <br />'TEST HOLES READY: <br />SiTE EYALUATiON NUIV~ER: <br />EXiSTiNG 'rANK SIZE: 500 <br />EXISTING ORAiN FIELD LINE~: <br />SEPTIC 'rANK PU~PED: 9-10-90 <br />PREVIOUS NO. BEBRFJOf4E,: 2 <br /> <br /> i'TEM (,~UAN'Fi'T'Y AMOUN'¥ <br />AU'I'HORiZA'f~ON NOTICE - FLD+ ¥iS1'T ~ 1 $105.00 <br /> : , <br /> r \~::~ : TOTAL ~ESSED FEES $105.00 <br /> ,-~/~5~' PREV~OU~RECEiPI'S $0.00 <br /> $105.00 <br /> ~ ' THt~ RECEIPT <br /> <br /> BALANCE DUE $0, O0 <br /> PAYEE: r~ILLiCAN, BiLL iNVOICE NO.* 28716 <br /> RECEIYED BY: CL 'TYPE: IN CHECK ~: 0 <br /> <br /> 5.~E AFl'ACHED OOCLIMEN'T' FOR RE~R~'rs OF ~-Sll'E SEWAGE SYSTEM. <br /> <br />~ THiS iS NOT A PE~IT. THIS APPLi~Ti~ ~T ~ TH~ A R~i~ P~ ~ERE THE <br />FOLL~[N6 ~ST BE ~PLETED. IT iS THE R~5IBILiTY OF THE APPLI~T TO ~RE THAT <br />ALL N~ INFO~TI~ H~ 8E~ P~VIDED. <br /> <br /> PLAN REVlEW~ BY........~_.,,,. DATE ..................................... ~~ CiTY JURiSBiC'I'ION: BY ............................. DATE <br /> <br />OFFICE COPY <br /> <br /> <br />