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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 />OWN~R~.. [ ~: i I/~.O/;.~l , ,[ MC,' 8; ~0: ,~- lAX LOT: CArEGORY: <br /> <br /> OOOPE.R, E ~E51. E <br />SITUS ADDRESS: CONSTRUCTION TYPE: OCCUPANCY: <br /> <br /> 170 N LgI_I'I [E -- CONTRACfOtTY: ' UG~i iOCCUPANT LOAD: ~'~'~' <br /> <br /> ........... OE f'RO~ ~: NO <br />USE OF BUIL~JN6: N0 0~ BEDR00M~ <br /> <br />PHONE: [~,J. 'T'~Z NUI~BER: ! 4 944 <br /> VALUA'T .f ON: <br /> <br /> ~, ..... ~8 5E <br /> 5o ~ oS ~,0. s~ r~o N9 <br /> <br />MAP: <br /> <br />PHO%E. <br /> <br />9038989 <br /> <br />WATER SUPPLY: CW <br />'f'EST HOLES ReADY: <br />SITE EVALUAf'.[QN NUMBER: <br />g%iS'~N~ 'rANK ~t~E: <br />EXiS'¥'ZNG BRA~N FIELD L~NES: <br />SEP'f'1C 'lANK PU~PED: <br />PREVIOUS NO. <br /> <br />~20 <br /> <br />REPAIR f~! NGR <br />AUf'H0~[ZA('tON NGI'ICE- NO ~[Sl'f' <br /> <br />TOTAL A~E~EO FEES <br />PREVIOUS RECE I P'I'~ <br />THIS R~CE,( PT <br /> <br />(~U.A,N'1' 11Y A~4OUN i' <br />1 $60. <br />· 1 $~,., oo <br /> <br />PAYEE: iNVOiCE NO: <br /> <br />$ '125,00 <br /> <br /> $o_00 <br /> <br />$15.00 <br /> <br /> R~:CEiVED BY': CL TYPE: - CHECK ~: 0 <br /> <br /> SEC ATTACHED DOCU~EN'f FOR REQUiREmENTS OF ON-'SiTE SEWAGE <br /> <br /> ~ THiS IS NOT A P~IT. THIS APPLICATION f~tJST ~O THROU614 <br />EOLL~ING ~T BE ~PLETED. ZT ~ THE R~[~IL[TY OF THE APPL[~T TO ~RE THAt' <br />ALL NEC~ INFO~Ti~ H~ BE~ <br /> <br />?LAN REVIEIN: dY ................................... OAJE ................................ <br /> <br />REP4ARKS,, LOAN RE'POP) / MINOR REPAIR <br /> <br />O.[TY ,JURISDiC'T'iON: ~Y ............................. OATE ................... <br /> <br /> OFFICE COPY <br />FORM # MC 15-58 REV. <br /> <br /> <br />