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MARION COUNTY BUILDING INSPECTION <br />SENATOR- BLD,G'~ NO. 225 <br />220 HIGH STREST NE <br /> SALEM, OREGON 97'301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE~A-PHONE: 588-7904 <br /> <br /> f am performing work Or1 8 property I OWr] or occupy, <br /> <br /> of a re§istered builder, <br /> <br /> I)A'ff'":: 1'1/27/91 '~E= 16:45:02 <br /> <br />ow~: COOPER, ELSIE <br /> <br />[)E ! F,'().[ T' OR 97,342 <br /> <br />TAX LOT: : CATEGORY: <br /> S: ' OCCUPANCY: <br /> <br />DEN f 1 AL <br /> <br />DE"I'RO i 'r' NO <br /> <br />F~'-I ON E: <br /> <br />SI, TE NUMBER: 1A944 <br />VALUA I LgN: <br /> <br />W DTN' ~ DFPTH. ] 00! AREA: 500[,]. ..NITS: ~p c'C'EG. LO'I: NO CORNEreD <br /> <br />'.)EF-~Mi T (,)R A'2PL;iCA"I'iON NO: <br /> <br />C'O,N r RACiOR, NO, <br />C(.:~)P ER, EL,'5 I_ E <br /> <br />PHON(:!:: <br /> <br />WATER ~UPPLY; CW <br />TEST HOLES READY: <br />Di'I'E 5VALUA]'iON NU~/BER: <br />EX~S'f'ING 'rANK SIZE: 7.50 <br />EXIS'rZNG DI;b&tN FZEL0 LiNE~: <br />~EP'f~C 'IANK PUMPED: 1]~16'-91 <br />PREVIOUS NO. BEDROO~S: ~ <br /> <br />'12g <br /> <br /> ~I~M QUAN'T'LTY AtvOUNI <br /> E:XISI/NG SYS'[EM EVAL. RPF. '1 $110_00 <br /> <br /> TO'T'AL ~E~O FEES <br /> PRE%/IOW$ RECEiP'rS $o,oo <br /> THIS R~CEiP'T' $]10.00 <br /> <br /> BALANCE DUE <br /> <br /> PAYEE; CO0~ER, ELSIE tNVOIC~ NO: <br /> RECEIVED ~Y: 0~2 TYPE: IN CHECK ~: 0 <br /> <br /> SEE: A'f'I'ACHED DOCU~EN'I' FOR REQUZRE~EN'f'S OF ON-SiTE SENABE SYS'I'E~. <br /> <br /> ~ THI~ iS NOT A PERI'4IT. THI~ APP~iC;ATiONI'vlUST GO THROUGH A RE'ViEW PROCL~3 <br />~FOLLO~ING IWJST ~E CI~I~IPLETED. [T I5 THE RE~PONSIBiL/TY OF THE APPLICANT TO ,e,,S,~JR~ THAI <br />ALL NECEE~,..~ARY [NF~ORIVlAT[ON HAS. B~EN <br /> <br />PLAN R~ViE~;: DY ................................ <br /> <br />P, ElVtARK~ LOAN REPOR'f <br /> <br />OA'f'~. ........................................ <br /> <br />Ci'fY JURISOiC'IiON: BY ............................... DATE <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 REV. 4j90 <br /> <br /> <br />