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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO 225 <br />220 H~GH STIR~T 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 /> DATE <br /> <br />OWN~IE: 09112/91 lIME: <br /> <br />TAX LOT <br /> <br />CONSTRUCTION TYPE <br /> <br />90250-U!~0 <br /> <br /> 320 LAK~CRbSf OR <br /> DETROi1 OR 9'f342 <br />USE OF BUILDING <br /> <br />CONTRACT CITY <br /> <br />UGB <br /> <br />NC) <br /> <br />SUBDIVISION <br /> <br />4087 PA~.OE~ <br />I->F'K.)N ~ <br /> <br />SiTE NUMBER~ 1362~ <br /> VALUAfION: <br /> <br />I 0 5E <br /> NO , NO <br /> <br />fYi~E: ON bL id i,~i~W,AGE <br /> <br /> WAFER ~PPLY: CW <br /> lEST HOLES RF~DY: <br /> <br /> EXI51iN~ TANK SIZE: <br />' EXiSflNG DPC~],N PiELO LINES: <br /> S~PI[~ ~ANK PUMPED: <br /> PRE'VIOU5 NO- B~ORO(~5~ <br /> <br /> [ / EM ~ ~ (~t,J~ 1 l I Y &NFOUN I <br />:b~ lb,, t:VAL_UAfiON, PIRST LO[ ~ 1 $1/5.00 <br /> <br /> ) PREVia5 RECEi PI-S $1 'f b - CrC) <br /> ]Hi~ R~C~P~ $O_OO <br /> <br /> ~ALANCE DUE $C <br />ix[ LJvbl) MY: ct ........................................................ ~YPE: CHECK ~; C <br /> <br />NOTE: THIS OOF_~ NOT 6RAN1 OR IMPLY PERI~II~iON TO BUILD ON THIS PARCEL. PLANNIN~ ~0 <br />CONSTRUCTION PER~4IT$ Iv~JSf BE OSTAINEO BEFORE BUiLdING OR ~EPTIC INSTALLATION BEGINS_ <br /> <br />JONALD b- WOODLE¥, MAR[ON COUNIY WL IL. DING OFFICIAL / BY .........~ <br /> <br />~o~ ~ ~c ~5,s~ R~v .~.~ OFFICE COPY <br /> <br /> <br />