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MAHIf.)N (.;gUN I Y ~UILL)INL~ IIN~I~I-E,I IL)IN <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 />LP~AGJ I:LD, RAYt~ON D <br /> <br /> 120 LAKECRESr DR <br /> DNI RL)I 1 OR 97342 <br /> <br />L}SE OF BUILDII~ <br /> <br />243? 5W SEYMOUR OR <br />PORILAND OR 97201 <br />PHONE: 2~4-6887 <br /> <br />TAX LOT <br /> 90~0-010 <br />¢o~ s~ n ~c-f~6-~'-~ ....... <br /> <br />OOCUPANCY <br /> <br /> ,_~)~TRACT CITY .... T'~B .... --O~'6~PAhT LOAD <br /> ~-~ ROii ......... beg ............ ~F~'~,oo~s <br /> <br />............ su~mvmsib~ .................... <br /> <br /> .............. ~!~ ~.J ............................. <br /> <br /> SITE NUF~ER: 14108 <br /> VALUAT I ON: <br /> <br /> 5JE_ ~ .~ .... <br />10 _ RR~G LOT ~RN~R <br />5P NU J NO <br /> <br />PEril OR APPLiCA][ON NO: 35132 <br /> <br />CON FRAC~OR, No. <br />LEAfiJELD, RAY.ND <br />2437 8N 5EYM(]UR OR <br />PORILAND OR 97201 <br />~ONE: 244-608? <br /> <br />WAFER ~UPPLY: CW <br />lEST HOLEL~ READY: <br />~[FE ~WALUAYtON NUMBER: <br /> <br />~iSTiNG D~IN FIELD <br />SEPI'IC I~K PUMPED: ~/A <br /> <br />168 <br /> <br /> I fE~4 <br />AL I ERA f J <br /> <br />$150.00 <br />$65.00 <br /> <br />AUIHORiZA(~ON NOIiC6 - NO ¥[,.~[-'{' ::: <br /> <br /> . T0.]~AL~'~ ~ESS~D;~ ~EE~ $ 215_ 00 <br /> PRE~I~:~ECE'~'P~' : $215. O0 <br /> <br /> $o. <br /> O0 <br /> <br />:.~.:=-. .,,: ., ,,,,.,..,, , : <br /> <br /> ~V' T~ eR USGS/ AU,TN~& ALTR .A <br />REMARKS: EXiSIING 5~P'flC,;' ER'.H~0OKE~'UP ' ' "'~' ' ' <br />OONAI_D g. WgODLE¥, ¢4ARiON .~I~UI~D~NG ~FEi. CtAL¢/ 8% <br /> <br />OFFICE COPY <br /> <br /> <br />