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MARl,ON COUNTY BUILDING INSPECTION, <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-514.7 8:00 -4:$0 <br />24 HOUR CODE~A-PHONE: 588-7904 <br /> <br />l am a registered builder OR ( ) the authorized representative <br /> <br />The 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: 08/27/92 TIME: 17:05:30 <br /> <br />SIGNATURE OF APPLICANT; <br /> BATE: <br /> <br />I°wNER:STRASSHOFER, JIM & PIPER , RESIDENTIAL <br /> ADDRESS: <br /> <br /> 320 SANTIAM AVE <br /> DETROIT OR ' , _ . .... <br /> <br /> H~HHONB DZV~SZON TO DETROZT~ <br /> [5200 [ROM HT BLVD <br /> PORTLAND OR 97219 SITE HUMBER: 92-02443 <br /> PHONE: ~5--7903 VALUATION ~ <br /> <br /> : ~LOOK: ] SAd¥'ibN: ..... ;'~GW~IPi i RANG~: i ~ON~: : MAP: <br /> <br /> m <br /> ~0 ~O~h;i ' AREA: , UNIT~: i ~RREG. LOT; , CORNER: <br /> 158 i 6900. ~F NO ~ NO <br /> <br />TYPE: ON-SZTE SEWAGE ~ATER SUPPLY: CN <br /> <br />PERMIT OR RPPLICATIOH NO: 9040997 <br /> <br />~ONTRACTOR, NO. <br />BTR~SSHOFER, JIM & PIPER <br />iZ200 IRON MT BLVD <br />PORTLAND OR 97219 <br />PHONEs 6~5~"7903 <br /> <br />TEST HOLES READY: <br />SITE EVRLUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES; <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO, BEDROOMS: 2 <br /> <br /> ITEM QUANTITY AMOUNT <br /> REPAIR -- MA3OR 1 $105.00 <br /> AUTHORIZATION NOTICE - NO VISIT I $80.00 <br /> <br /> TOTAL ASSESSED FEES $185.00 <br /> <br /> PAYEE: STRASSHOFER, JIM & PiRER INVOICE N~: ~).¢..D 44253 <br /> RECEIVED BY: el .................. ............... TYPE: IN CNE~K ~s 0 <br /> <br /> SEE ~TT~CHEB DOCUNENT FOR REqUiREmENTS OF ON~S~TE BENAGE SYSfEN. <br /> <br />m THIS IS NOT A PERMIT. THiS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORMATION HAS BEEN PROVIDED. <br /> <br />REHARKS: ,qUTH/ mm~or r.e..~,ir <br /> <br />CITY JURISDICTION: BY .............. DATE ...................... <br /> <br /> OFFICE COPY <br />FORM # MO 15-66 REV. 4/90 <br /> <br /> <br />