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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:$0 <br />24 HOUR CODE-A-PHONE:: 588-7904 <br /> <br /> O~hor <br /> <br />OArf=~ 08/30/91 liME; 16:15~55 <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br /> T&X LOT <br /> <br /> CONSYRUCT~ON TYPE <br /> <br /> 8144 AUM.SVI. LLE HWY SE <br />AUIvlSVi LLE OR 9?325 <br /> <br />CONTRACT CITY UGS <br />i~IAR I ON COUN f Y NO <br /> <br />MAILING ADDRESS <br /> <br />BOX 13611 <br />SALEM OR 9?309 <br />PHONE; 581-2767 <br /> <br />LOT 8LOCK SECTION <br /> 17 <br />WEOTN DEPTH AREA <br /> <br /> TOWNSHIP <br /> <br />5.64 AC <br /> <br />SANI lAM M~-ADOW5 <br /> <br /> 511~ NUC4BBR: 12Yll <br /> VALUAf'iON: <br /> <br />RANGE ZONE <br /> <br /> 2W AR <br />I~REG LOT CORNER <br /> NO NO <br /> <br />CATEGORY <br /> RE5i UkN I J~L <br /> <br />OCCUPANCY <br /> <br />OCCUPANT LOAD <br /> <br />3 <br /> <br />MAP <br /> <br />[YPE: ON-51~E SEWAGE <br /> <br />PEP. MIi OR APPLiCAflON NO: 34635 <br /> <br />CONiRACfOR, NO. <br />MORGAN, K~N <br />BOX 13611 <br />SALEM OR 97309 <br />PHONE: 561-2767 <br /> <br />NAr'ER ~JPPLY: PW <br />T'BSI HOLES RP.~ABY: <br />5iFE EYALUAFION NUMBER: 31511 <br />EXiSTiNG lANK SIZE: <br />EXISTING DRAIN FIELD LiN~5: <br />~P'flC lANK PUMPED: <br />PREWIC:~,J5 NO. BEDROOMS: <br /> <br />5E < 6 MONTHS OLD <br /> <br /> TOTAL ~ED FEES <br /> PREA/iOUS RECE~PI'S <br /> <br /> BALANCE DUE $0.00 <br /> <br />PAYEE: RECEiPI NO: <br />RECEIVED BY: DM2 FYPE: C~ECK ~ 0 <br /> <br />5~E Al' IACH~D DOCUMENt FOR REQUIRFJ~ENfS OF ON-Si [E SE~AGE SYSFEM_ <br /> <br />~U.,~&JflfY AJvCDUN[ <br /> 1 $110.00 <br /> <br /> ~110.00 <br /> 110.00 <br /> $0.oo <br /> <br />~ THIS IS A VALID PERi, IT * THIS PEt~IlT EXPIRES 360 OAY~ PRO~ ITS ISSUE DAT~. iF <br />OONSTI~JCTION FAILS. TO ~EET ALL REOUIRE~IENTS OF STATE LAt,~ AND I~ARI(IN COUNTY BUILDING AND <br />ZONING ORDINANCES. THiS PER~IT SH~LL BECOME NULL~DVOiD. <br /> <br />NEW SEPflC R~2857 <br /> <br />DONAL0 b. ~DLEY, MARION COUNIY BUILDING OFFICIAL / BY <br /> <br />~ORM ~ MC ~S~ RE~' ~/~o OFFICE COPY <br /> <br /> <br />