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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 am a registered builder OR ) the autnorlzed representative <br />of a registered builder. <br />The work wilr be cerformed by a registered builder, <br />Other <br /> <br />OWNER'. <br /> <br /> NEL~JJYJN, KAI'HLEEI~ <br />SITUS ADDRESS' <br /> <br />1,0:37:22 <br /> <br />TAX LOT <br /> <br />CONSI'C!UCTION TYPE <br /> <br />CATEGORYz <br /> <br />OCCUPANCY; <br /> <br />RES I DEN'f ,~ ¢ <br /> <br /> 78?7 BARBARA LANE <br />AUM~VI LLE OR 9?325 <br /> <br />USE OF BUILD~NO: <br /> <br />SE '60NTRACT CITY <br /> ....... MARi. ON. 6OUNIY <br /> <br />PO 366 <br />STAYTON, OR 9?383 <br />PHCNE: 769-1424 <br /> <br />LOT' BLOCK SECTION TOWNSHIP <br /> <br /> 2 5 28 . 8S <br />WIDTH'. OEPTH ARE,~ JNIT~ <br /> 3.87 AC <br /> <br />THE P-J~NCH <br /> <br />~ll'E NUIV~EN~ 92w01893 <br /> VALUAT I ON: <br /> <br />qREG, LOT CORNER <br /> NO NO <br /> <br />TYPE: ONmSlTE SEWAGE <br /> <br />PEmIT oR APPLICATION NO: 40059 <br /> <br />CONTRACTOR, NO. <br />NELSON, KA'rHLEEN <br />PO 366 <br />STAYTON, OR 97383 <br />PHONE: 769-14~4 <br /> <br />WATERS UPPLY: PW <br />TEST HOLF.5~ READY: <br />SiTE E~ALUATiON NUIV~ER: 'rHE RANCH <br />EXISTING TANK SIZE: <br />P.C<iSTiNG DRAIN FIELD <br />SEPTIC TANK PUMPED: <br />PRE"ViC~S NO+ <br /> <br /> I'I'EI~ QUANTITY AMOUNT <br />STANDARD ON-SiTE SYSTP.:~ 1 $210.00 <br /> <br /> I'OTAL ASSESSED FEES $210.00 <br /> PRE~iOUS RE~EiP'rS $2~0.00 <br /> THiS RECE~P'f' $0.00 <br /> <br />BALANCE DUE $0,00 <br /> <br />PAYEE: <br />RECEiVEDBY: P8 <br /> <br /> 'FYPE~ <br /> <br />SEE AT'FA(.,,'HED DOCUM~N'F FOR REQ)UIRET, I~T$ OF ON-SITE SE~.GE SY~'FEf~. <br /> <br />RECEIPT NO: <br />CHECK <br /> <br />* THiS I5 A VALID PER~IT * THI~ PERi,IT EXPiRE~380 OAY~ FR(~ ITS iE~.~UE DATE. IF <br />CONSTRUCTION FAIL~ TO ~EET ALL REOUIRE~ENTS OFSTATE LA~5 /~D ~ARION COUNTY BUILDING AND <br />ZONING ORDINANCE~, THIS PER~ITSHALL BE'~C~ENULLAND VOID. <br /> <br />RP3NIAR~: PERNIT <br /> <br />DONALD E. NOODLEY, MARioN COUNTY BUILDING OFFICIAL / BY <br /> <br />OFFICECOPY <br /> <br /> <br />