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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STREET NE <br /> SALEM, ORF:GON 97301 <br /> <br /> PHONE: 588-5147 8:0o - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />l am a registered builder OR ( ) the authorized representative <br /> <br />Yhe work will be performed by a registered builder, <br />Other. <br /> <br /> I have read and agree to the terms Stated on the reverse side of <br /> this document. <br /> <br /> DATE: 01/30/92 TIME: 9:57:42 <br />OWNER~ <br /> RASB, JOSEPH <br /> <br />SITUS ADDRESS: <br /> <br />SIGNATURE OF APPLICANI: <br /> <br />DATE~ <br /> <br />TAX LOT: <br /> 678-0198 <br /> <br />CONSTF1UCTfON TYPE: <br /> <br />CATEGORY: <br /> <br />OCCUPANCY: <br /> <br />RES i DEN l' l AL <br /> <br /> 415 CLES'FER RD -- CONTRAcT cITY: UGB: <br />DE'T'ROI T OR 9'7342 <br /> E)E'I'RO I T NO <br /> <br />OCCUPANT LOAD: <br /> <br /> NO OF BEDI100M5 <br /> <br /> 2 <br /> <br />~t103 268 /AKESHORE RD <br />BOULDER CiTY NV 890rJ5 <br />PHONE: '?02-293-5480 SiTE NUMBER: 92-00~.5~ <br /> VALUAT iON: <br /> <br /> 2 10 5E <br /> 80 80 6400. SF' NO NO <br /> <br />MAP: <br /> <br />TYPE: ON-'SiTE SE;WAGE <br /> <br />PERMIT OR APPLiCATiON NO: 37854 <br /> <br />CON'f R. AC'roR, NO. <br />RASB, JOSEPH <br />~103 268 "IAKESHORE RD <br />BOULDER CiTY NV 89005 <br />PHON~: 702.-29~f5480 <br /> <br />WATER SUPPLY: 0!4 <br />TEST HOLES READY: <br />SiTE EVALUATION NUMBER: <br />Ec~<I$'FiNG TANK SIZE: <br />EX.ISTJ. NG ORAJ. N FIELD LJ. NES: <br />SEPTIC TANK PUMPED: <br />PREV.[OUS NO+ 8EOROOMS: <br /> <br /> ITEM OUANTI'IY AMOUN'I <br />AL.i'ERA'rioN 1 $150.00 <br /> <br /> TOTAL ~ED FEES $150.00 <br /> PREVIOUS RECEIPI'$ $150,00 <br /> THiS RECEIPT $0_00 <br /> <br /> BALANCE DUE <br /> <br /> PAYE~: ~NVOiCE NC): <br /> RECEIVED BY: DM2 TYPE= CHECK ~: 0 <br /> <br /> SEg All'ACHED DOCUMENT P'OR REQUiRENENTS OF ON-SITE SENAGE SYSTEM. <br /> <br />* I'Hi~ 1~ A VALID P~RI~iT * THIB PBRRiT e~KPIRF~ 380 DAYS FRO~I iTS I~E <br />~T~CTI~ FAi~ TO MEET ALL R~iR~TS OF ~TAT~ ~ ~D ~RI~ ~NTY BUILOING <br />Z~iNG ORDIN~C~, THI~ PE~iT ~ALL BEdE NULL ~0 <br /> <br />REMARKS: ALTERATION <br /> <br />DONALD E. INOOOLEY, MARION COUNTY BUILDING OFFICIAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 REV. 4/90 <br /> <br /> <br />