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MARION COUNTY BUILDtNG INSPECTION <br />SENATOR BLDG. NO 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE:: 588-5147 8::00 - 4::90 <br />24 HOUR CODE-A-PHONE:: 588-7904 <br /> <br />Othor. <br /> <br />have read and agree to the terms stated on the reverse side of <br /> <br />SIGNATURE OF APPLICANT <br /> DATE <br /> <br />OWN~ f E'- 09/20/91 FINE: <br /> H¢-~I fETER, BURL <br /> <br />8:45:16 <br /> <br /> TAX LOT <br /> <br />:CONSTRUCTION TYPE <br /> <br /> 5852 VILLAGg Vi~ Cf' <br /> AUr4SVlLLg, OR 97325 <br />USE OF BUILDIN~ <br /> <br />CONTRACT CITY : DOB <br />FIARION OOUN I Y . <br /> <br />PARIYKA, 51ANLEY : RENIOR <br />SAME <br />PHONg: 588-??22 <br /> <br />LOT BLOCK SECTION TOWNSHIP <br /> <br />NO <br /> <br />565 <br /> <br /> 18 <br />AREA <br /> <br /> 1084~0. <br /> <br />UNITS <br /> <br /> SIIE NUIVlBER: 15908 <br /> VALUA r I ON; <br /> RANGE ZONE <br /> <br />8S lW AR3 <br /> IRREG lOT CORNER <br /> <br />SF NO NO <br /> <br />CATF. GOR~ <br /> RESI D~N l [,~/- <br />OCCUPANCY <br /> <br />OCCUPANT LOAD <br /> <br />NO OF BEOROOM$ <br /> <br />3 <br /> <br />TYPE= ON-511E SEWAGE <br /> <br />PEF~IT OR APPLICATION NO: 34667 <br /> <br />CON rRAC foR, NO. <br />HOSt rErER, BURL <br />PARTYKA, $¥ANLEY ; REN]OR <br />SA~E <br />PHONg: 588-7722 <br /> <br />NAIER ~:AJPPLY: <br />FF~SF HOLES READY: <br />Si1E EVALUAIION NUFISER: <br />EXISFING rANK SIZE.· 1000 <br />E,~iS'IlNG DRAIN PIELD LINES: <br />SEPTIC IANK PUNPED: 8-21-91 <br />PRE~'IOUS NO. BED~: 2 <br /> <br />AUIHORiZAflON NOIICE - FLD. ViSiI <br /> <br /> r,,~UANIiYY A~OUNf <br /> 1 $105.00 <br /> <br />TOTAL ~ES~EO FEES $105.00 <br />PREVIOUS RECEIPTS $105.00 <br />tHIS REC£IPr $o.oo <br /> <br /> $0.00 <br /> <br />BALANCE DUE <br /> <br />PAYEE: RECEIPT NO: <br /> <br /> RECEIVED BY: P8 ....................................................................... 1YPE: C~ECK ~: 0 <br /> ~ Al TACHES BOCUMEN1 FOR REQUIREMENf~ OF ON-BilE SEWAGE SYSIE~. <br /> <br />$ THiS IS A VALID PERIflIT · THIS PERI, iT EXPIRES 360 DAYS FROiVl ITS ISSUE DATE. IF <br />CONSTRUCTION FAILS TO ~EET ALL R~I~UIRI~,IlBNTS OF STATE LA~ AND BiARION COUNTY 8UILOING AND <br />ZIANINGORDiNANCIBS, THIS PER,lIT SHALL 8F=CO~IENULLANOVOID. <br /> <br />RBMARKS: AUTH F~6779 ~ <br />DONALD E. {~OODLEY, MARION COUNfy BUiLDiNG OPFICiAL / BY <br /> <br />FORM # MC, 15-56 REV 4190 OFFICE COPY <br /> <br /> <br />