Laserfiche WebLink
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 />SIGNATURE OF APPLICANT <br /> 0ATE <br /> <br />90221-150 <br /> <br />OCCUPANCY <br /> <br />RESl DIN fiAL <br /> <br /> 200 ~:~NTIAN AVE <br />DEIROI1 <br /> <br />OR 97342 <br /> <br /> CONTRACT CITY <br /> <br />DE1 ROi 1 <br /> <br />UGB <br /> <br />ND <br /> <br />2150 34tH AVE NE <br />5AL~M, OR 9?303 <br />PHONE: 383-55?8 <br /> <br />LOT SLOCK SECTION TOWNSHIP <br /> <br />HAI~t~JN D <br /> <br />SITE NU~ER: <br /> VALUA r i ON: <br /> <br />12674 <br /> <br />MAP <br /> <br />2 <br /> <br />WIDTH <br /> <br />1 1 nEPTH 9 A~EA 2 <br /> UNITS <br /> <br /> 50 150 . '~ 5 O.O <br /> <br />l0 mREG LOT ' 5E iCORNEn <br />SP NO NO <br /> <br />IYPE: ON-SIrE <br /> <br />PERNIF OR APPLiCAtION NO: 31578 <br /> <br />CONrRACfOR, NO. <br />HOLOUBEK,ROBERI <br />2150 34FH AVE NE <br />~,AL~M, OR 97303 <br />PHONE: 363-5578 <br /> <br />WATER E~JPPLY: O~ <br />'f~'f HOLES READY: <br />SIrE EVALUAFiON NU~ER: <br />EXlSIING f'ANK SIZE: 550 <br />EXISTING DRAIN FIELD LIN~: <br />~EPIiC F~K ~MPED: <br /> <br /> i'I E?~ <br />AUTHORIZAflON NOTICE - ELD. Vi~iT <br /> <br /> QUANTI)Y AMOJNI <br /> 1 $105.00 <br /> <br />TOIAL ASSESSED FEES $105.00 <br />PRE~iOUS RECEIPTS $105.00 <br />IHiS RECEIPT $0.00 <br /> <br />EALJ~NCE DUE $0+00 <br /> 0 <br /> <br /> PAYEE: iNVOiCE NO: <br /> RECEIVED BY: CL TYPE: CHECK <br /> <br /> SEE Af'FACHED DOCUMENT FOR RE~XJiRE.314ENl'S OF ON-SiTE SEWAGE SYSTEN. <br /> <br />~ THiS IS A VALID PERNIT ~ THIS PE~IT ~PI~ 360 ~ <br />~T~CTI~ FAi~ TO ~T ALL R~IR~TS OF ~TATE ~ <br />~ING O~IN~C~, THIS ~IT ~L <br /> <br />RE]4AR~: AUFH ~ FIELD CHECK ~ <br />DONALD E. ~OODLEY, ~RiON COUNTY BUILDING OFFICIAL / bY )'/'~'~ <br /> <br />~ORM ,~ MC ~S s~ n~ .¢~0 OFFICE COPY <br /> <br /> <br />