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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 />Other <br /> <br />D~,fE~ 05/28/9] fiP4E~ 10::~8¢26 <br /> D fW HOMES <br /> <br />SITUS ADDNbSS <br /> <br />SIGNATURE OF APi~LIC&NT <br /> DATE <br /> <br /> TAX LOT <br /> <br /> CONSTRUCTION 'TYPE <br /> <br />RESiOEN 1 .(AL <br /> <br /> 1470'! ALSER"~ WAY NE <br />AURORA OR 97002 <br /> <br />USE OF 8UILGING <br /> <br />MAIl, lNG ADDRE~S <br /> <br />24?55 ~W 65lB <br />]UALAiIN, OR 97062 <br />PHON~ 638-8297 <br /> <br />LO~ EILOGK SECTION TOWNSHIP <br /> ~ ] ~2 <br /> <br /> CONTRACT CITY <br /> <br />AURORA <br /> <br />4S <br /> <br />UGB <br /> <br /> NO <br /> <br />~11E NUMBER: 13087 <br /> VALUAfION: <br /> <br />RANGE ZGNE <br /> <br /> lW RI <br />IRREG~OT NO COI~NE~ES <br /> <br />MAP <br /> <br />fYPP-.; ON-~ITE SEWAGe: <br /> <br />PERMiF OR APPLiCAF~ON NOt <br /> <br />O%)NFRACFOR, NO. <br />DTW HOMES <br />24?55 5W 65lB <br />TUALATiN, OR 9~062 <br />PHONE: 638~8~91 <br /> <br />9032495 <br /> <br />WATER rSUPPLY: CW <br />]ESi HOLDS READY: <br />51rE EYALUAfiON NUMBER: 10483 <br />EXISIiNG lANK SIZE: <br />E}<ISIING 0RA. iN FIELD LINES: <br />5EPIlC rANK <br />PR~¥tOUS NO. <br /> <br /> 51ANDARO ON-SIIE SYSI~v] ~ ] $lG5-00 <br /> <br /> IOTAL A.S.SESSEO F~E$ $1~5.00 <br /> PR£V~OU$ RECEIPf'S $0_00 <br /> rHi5 RECEIPf $~65_00 <br /> <br /> BALANCE DUE <br /> <br /> PAYEE: 0iN CONsIRU~FJ~SN-0f~;NNI8 INOLF iNVOiCE NO: 34289 <br /> RECEiVEU BY: pn ~"" FYPE$ iN CHECK ~: 0 <br /> 5E~ AfFACH~D DOCUMEJ'~F FOR REEJJIRESVlEN'f'~ OF ON-S~fE ~EWAGE SYS~E~. <br /> <br />* THIS IS NOT A PERffilT. THIS APPLICATION IvlUST GO THROU61-1A REVIE~ Pi~X;~ I~-IERE THE <br />FOLLO~IN6 ~LIST 06 COffiPLETEB, IT iS THE RESPONSIBILITY OF THE APPLICANT TO ~RE THAT <br />ALL NBCE~AFC¢ INFOi;~'¥tATION HAS BEEN PROVIDED. <br /> <br /> RE~ARK~: ~EPfIC INSfALLAfiON <br /> <br /> OFFICE COPY <br />FORM # MG 15-5~ REV 4/90 <br /> <br /> <br />