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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 />I am performing WOrk on a property I own or occupy <br />I 8m a registered builder OR the authorized representative <br />of a registered buiSder, <br />The WOrk will be performed by a registered builder. <br />Other <br />I have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> DATE: 05/08/92 <br />OWNER <br /> FOOTE, KEN <br /> <br />Sr~uS ADDRESS <br /> <br />TIME: 8:0g:IB <br /> <br />TAX LOT <br /> <br />CONSTRUCTION TYPE <br /> <br />90221-240 <br /> <br />CATEGORY <br /> <br />OCCUPANCY <br /> <br /> 290 SAN'FIAM AVk <br />DETROIT OR 9'7242 <br /> <br />JSE OF BU LDING <br /> <br />CONTRACT ]ITY. <br /> <br />DE'IiROJ, I <br /> <br />UGE <br /> <br />NO¸ <br /> <br />MAlt. lNG ADDRESS: <br /> <br /> 1922 BET~VER LP NW <br />~LEM OR 97304 <br />PHONE: 588-2950 <br /> <br />LOT: <br /> <br /> 2O <br /> <br />SUBDIVISIOh <br /> <br />HAIVlMOND ADDi'f'ON <br /> <br /> 9 2 <br />50 1 :~9 5950 _ .~F <br /> <br /> SiTE NUr,~gB: 92-01337 <br /> VALUAT ION: <br /> <br />RANGE ;~ONE: <br /> <br /> RREG LOT' CORNER <br /> NO NO <br /> <br />RgSiDENI'IAL <br /> <br />OCCUPANT LOAD: <br /> <br /> NO OF BEDROOMS <br /> <br />MAP, <br /> <br />I YPE: ON-Si'I'E SEWAGE <br /> <br />P~-F~II'F OR APPLICATION NO: :~9122 <br /> <br />CONTRACTOR, NO. 36421 <br />KBViN 'S BACKHOE <br />P O BOX 465 <br />OETROI 'f', 97342-0000 <br />PHC,NE: <br /> <br />IA~.'T'ER SUPPLY: L,'~ <br />l'~'I HOLrd..5 READY: NO <br />SITE EYALUA'I'ION NUIVlaER: <br />EXIS'T'IN~ I'~K SIZE: <br />~i8TiNG B~iN PiELD LiN~: <br />SEPTIC 'f~K ~RPED: <br />PRE~I~S NO. 8EO~: 1 <br /> <br />i I'EM Q'~JAN'T' 1 TY AMOUNT' <br />REPAIR - NAJOR 1 $105.00 <br /> <br />'fOTAL A~g.'SSED FEES <br />PREWIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$105.00 <br />$105_00 <br /> $0.00 <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: INVOICE NO: <br />RECEIVED BY: CL TYPE: C~ECK ~: <br />GEE AT'FACHEO DOCUMENF FOR RE(.,'~iRE~ENTS OF (IN-SITE SE~,tAGE SYSTE~. <br /> <br />~ THiS IS A VALID PEI;~IIT * THIS PERRiTEXPiRES 360 OAY~ FRC~ ITS iSSUE DATE. <br />CONSTRUCTION FALLS TO MEET ALL REQUIRfB~IENTS OF STATE ~ AND MARION CGtJNTY BUiLDiNG <br />ZONING ORDIN~4CES. THIS PER/~IIT E~HALL BECOME NULL AND VOID. <br /> <br />REMARKS: MAJOR REPAIR <br /> <br />DONALD E. NOODLEY, MARION COUNTY BUiLDiNG OFFiCiAL / BY <br /> <br />OFFICE COPY <br /> <br /> <br />