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MARION COUNTY BUILDING INSPECTION <br />SENATOR OLDS, 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 />l am a registered buiLder OR ( )~heauthori~edrepresentative <br />of a registered builder, <br />The work will be ce;formed by a registered builder. <br />Other <br />have road and agree o the terms stated on the reverse side of <br />this document. <br /> <br />iOw~.[E. 05/18/9 'f'J, ME-* 14,:50:49 , TAX LOT: :CAfEgORY: <br /> <br /> NELSON, KA I'HLEEN : <br /> SITUS ADDRESS: : cONSTrUCtION TVR~: 'OCCUPANCY: <br /> <br />RESID~NIJ¢ <br /> <br /> ?8?? BA~,~.IErARA LANE ~E <br /> SUBLJ, MI'I'Y OR 9?395 <br /> .... ~R 16,~N CQUNIY. bid <br />USE OF BUILOINS; <br /> <br />PO 386 <br />S'¥'AYTON, OR 9'?383 <br />PHONE: 789-1424 <br /> <br />, SUBDIVISION: <br /> <br /> THE RANCH <br /> <br />NO ~b~dR00MS: <br /> <br /> 4 <br /> <br />LOT; <br /> <br />WIDTH: <br /> <br /> ~I'TE NUMSERt 92-01893 <br /> VALUA'f'~ON: <br /> <br /> 5 28 8~ RA 48 <br />DEPTH: AR E'~i U NITS; IRREG, LOT: :CORNER: <br /> <br /> 3.87 AC NO: NO <br /> <br />f'YPE: ON-SiTE SEWAGE <br /> <br />PERMIT OR APPLICATION <br /> <br />(,,;ONTRACTOR, NO_ <br />NELSON, KA'T'HLEEN <br /> <br />90~0059 <br /> <br />NA'FER SUPPLY; PW <br />'1'BS'T' HOLE~ REAOY; <br />SITE EYALUA'f~ON NUMBER: 'T'H~ RANC~ <br />EXiSTtNG 'TANK <br />EX~S'F£NG ORA. tN FtELO <br />SEPTIC TANK <br />PREVIOUS NO. <br /> <br /> S'IAYTON, OR 9?383 <br /> PHONE; 769-1424 <br /> <br /> STANDARDII'EM ON-SITE SYSTEM ~-"'~- ....................................... ~Y1 AMOUNT$2q0.00Z~%Z ..... <br /> 'T'OTAL A~E~ED FEES $210,00 <br /> PRE¥~OUS R~CEtP'T'~ $0.00 <br /> 'fHiS RECE~P'T' $210.00 <br /> <br /> BALANCE DUE $0_00 <br /> <br /> PAYEE; NELtSON, KA'f'HLEEN RECE~P'1' NO; 42'106 <br /> RECE~VEO BY= CL ....................................................................., .............................................. 'T'YPEt CK CHECK ~; 1797 <br /> <br /> SEE ATTACHED OOCUMENT ~OR REQU~REMF34'f'~ OF ON-S~'~'E SEWAGE SYS'f'E~. <br /> <br />~ TH~S ZS NOT A PE~T. TH~8 APPL%OATJ~ ~ST ~ TH~ A R~%5~ P~E~ ~ERE THE <br />FOLL~tN6 ~ST BE ~PLETE9. JT ~S THE R~S%B~LJTY OF THE APPLtC~'F TO ~RE THAT <br />ALL NEC~A~ ~NFO~T~ <br /> <br />REMARKS: PERMIT <br /> <br />C&'FY JURISDICTION: BY DA'rE <br /> <br />:E COPY <br /> <br /> <br />