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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 / /~X ~ / <br />I am performing work OH a Property I owr~ or occupy, <br />I am a registered builder OR the authorized repr, se~tative S,~NATURE OF APPL,CANT; ~/~/ /~X~ <br />The work will be performed by a registered builder, <br />Other , <br /> <br /> DA'[E:.,04/14/~2 TIME; <br />OWNER: TAX LOT CATEGORY <br /> <br /> BETHEL, DARRELL <br /> <br />R~ ~ENT'IAL <br /> <br /> 9550 SATES ROAD SE <br />AUM,~V~LLE OR 9?325 <br /> <br />CONTRACT CITY' uog OCCUPANT LOAD. <br />~AR1 rjN...6iOUNZ¥ ..B~J. <br /> <br />PO BOx (523 <br />S'T AY'f'ON 9'/'383 <br />PHONE: ?'69-28?4 <br /> <br /> 5iI'E NUMBER: 92-ClSO2 <br /> VALUATION: <br />LOT: ,eLOC~: ...... "~ECTION +0WNsHI~i ....... 'RANGE: ZONE MAD <br /> <br /> ~-: 8s !~ ................ ~.~ cs <br /> <br /> 1.5 ,AC N~ Y~S <br /> <br />:WIDTR: ;DEPTR: <br /> <br />TYPE: ON-Sl'l'g SEWAGE <br /> <br />PER~I'T' DR APPLICA'TION NO: <br /> <br />CONTRACTOR, NO. <br />BETHEL, DARRELL <br />PO BOX 623 <br />5f'AY'I'ON 9?383 <br />PHONE: <br /> <br />9039~89 <br /> <br />NA'I'ER ECJPPLY: PN <br />TEST HOLES REiADY; <br />~i'TE EVALUATiON NWMBERz 83-1948 <br />EXiSTiNG TANK SiZE~ <br />EXiSTiNG DRAIN F~ELD L~NES: <br />SEPTIC 'rANK PU~PEO: <br />PREVIOUS NO. DEDRO0~: <br /> <br /> (74JAN Ti 'F'Y AMOUN'F <br /> <br />TOTAL ~ED FEES $365.00 <br />PREVI~s RECEIPT5 $0. O0 <br />THiS RE~EIP'f' $355. O0 <br /> <br /> BALANCE DUE $0.00 <br /> PAYEE: DETHEL, ~ARRELL ~ ; ,RE'C~iP' NO: 41435 <br /> RECEIVED BY: DM2 ,..[~"/--~'",~,=;/........_... "YPE CK CHECK ~: 1038 <br /> <br /> SEE ATTACHED DOCUMENT FOR REL,~iRENEN]'S OP ON-SiTE SEWAGE SYSTEM. <br /> <br />* THiS iS NOT A PER~iT. THiS APPLICAT:ION I',~JST GO THROUGH A REViE~ PRCCESS ~ERE THE <br />FOLLO~ING MUST BE OONPLETED. [TISTHE RESPONSiBiLiTY OF THE APPLICANT TO ~RE THAT <br />ALL NECE~,~ARY iNFORfW~TION H~.~EI~ PROVIDED. <br /> <br />REMARKS: 5AND FILTER <br /> <br />DA,'I'E <br /> <br />OFFICE COPY <br /> <br /> <br />