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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 />) 8m i~erforrning work on a groeerty i own or occupy, <br />lamareglsteredbuilderOR( ) the authOrized representative <br />of a registered bLfilder, <br />The work will be performed by a registered builder, <br />Other <br /> <br />[ have read end agree to the terms stated on the reverse side of <br />this document. <br /> <br />CATEGORY: <br /> <br />OCCUPANCY: <br /> <br />R~IDENIiAL <br /> <br /> 7757 SHERMAN RD Sc' <br />AUt4SVI LLE OR 97325 <br /> <br />DtlARiON EXDUN'FY <br /> <br /> OCCUPAN 1 LOAD: <br /> <br />NO <br /> NO OF BEO~OOM$: <br /> <br />MAILING ADDRESS: <br /> <br />510 5~/ 7TH <br />SUBLINITY OR 97985 <br />PHONE: 789-5969 <br /> <br />2 <br /> <br />C.aC4ELLi HEJ;GH'I'~ NO+ 3 <br /> <br /> SITE NUIWSER: 10906 <br /> VALUATION: <br /> <br /> 29 8S IW AR <br />AREA: i UNiTS~ IRREG. LOT: CORNER: <br /> <br /> 1.987 AC NO YE~ <br /> <br />48 <br /> <br />TYPE: ON-SII'E ~L:~eAA/3E <br /> <br />P6F~iT OR APPLICATION NO~ <br /> <br />CC~TRACTOR, NO. <br />ANDAL_, D+F+ & 8.J. <br />510 S~ 7TH <br />SUBLIMI'TY OR 97385 <br />PHONE: 789-5969 <br /> <br />I'~AT6R EAJPPLY: PW <br />TE~T HOLES RP.3~.DY: <br />SiTE ~WALUATION NUMBER: CAMELLIA HEIGHT <br /> <br />~iS'rING D~ZN FigLD LINE~: <br /> <br />PR~I~ NO. BEO~ <br /> <br />STANDARD ON-SiTE SYS'rEJ~t <br /> <br />QUAN'['tTY AMOUNT <br /> 1 $155.00 <br /> <br /> ~165.90 <br /> 155100 <br /> $o.oo <br /> <br /> TOTAL A~R~Ii~-:~ED <br /> PREVI(~J~ RP.~EIPT$ <br /> THIS RECEIPT <br /> <br /> BALANCE BE <br /> <br />PAYEE: RECEIPT NO: <br />RECEIVED 8Y~ ~ 'tYPE: CHECK <br /> <br />8EE AT'f'~HEO ~M~T FOR R~I~T~ OF ~iTE <br /> <br />* THIS IS A VALID P~[~-* ~l~ PE~I~ ~[R~ <br /> <br />CONSTRUCT/ON FAII..~ TO MEET ALLRE~UIR~MENT$OFSTATE~ANDMARION COJNTY BUILDINEiAND <br />ZOniNG ORDINANCES, THIS PERMIT 5HALL BECOME NULL AND VOID. <br /> <br />REJ'~I~4E,: NEW SEPTIC R~2355 <br /> <br />DONALD g. ~DODLEY, MARION COUNTY B01LDiNG OFFIC[AL / BY <br /> <br /> OFFICE COPY <br />FORM # MC 15,56 REV, 4/99 <br /> <br /> <br />