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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:S0 <br />24. HOUR CODE-A-PHONE: 588-7904 <br /> <br />lamaregisteredbullderOR( ) the authorized representative <br />The work wlll be performed by a registered builder. <br /> <br /> ?~X I.~¥i ; ~TEGORY: <br />OWNER; <br /> <br /> 10:16:00 <br /> DATE: 06/30/92 T!ME: <br /> ~ OCCLJPANCY: <br />$)TU~ A~DR£SS; <br /> ROTH. ROOER ~ ~ RESIDENTIAL <br /> ~ CONTRACT CITY: UGS: ~OCOUPANT LOAO: <br /> <br /> OF aUILD ~'iO-' ER ~N '~'~RE~ <br />USE ~TROIT 0R 97342 DETR0[T <br /> <br />MAILING ADDRESS; SU ~OIVISION; <br /> <br />SANE <br /> SITE HUMBER: 92=,02222 <br /> <br />100 110 11000. SF NO NO <br /> <br />TYPE: ON-S[TE SEWAGE <br />PER~IT OR APPLICATION NO: 40604 <br /> <br />CONTRACTOR, NO. <br />ROTH, ROGER <br />SAME <br /> <br />PHONE: 854-3728 <br /> <br />WATER SUPPLY: ow <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUNPEO: <br />PREVIOUS NO. 8EDROONS: <br /> <br /> ITEM QUANTITY AMOUNT <br /> EXISTING SYSTEM EVAL. RPT. i $150.00 <br /> TOfAL ASSESSED FEES $150.00 <br /> PREVIOUS RECEIPTS $1~0.00 <br /> THIS RECEIPT $0.00 <br /> <br /> BALANCE DUE $0.00 <br /> <br /> PAYEE: INVOICE NO: <br /> RECEIVED BY: DM ...... ~ __ TYPE: CHECK #: 0 <br /> <br /> SEE ATTACHED DOCUMENT FOR REQUIREHEN~S OF ON-S'I~E SEWAGE SYSTEN. <br /> <br />* THIS IS A VALID PERHIT · THIS PERMIT EXPIRES ~60 DAYS FROH ITS ISSUE DATE. IF <br />CONSTRUCTION FAILS TO MEET ALL REQUIREMENTS OF STATE E'AWS AND MARION COUNTY BUILDING AND <br />ZONING ORDINANCES, THIS PERMIT SMALL BECOME NULL ANO VOIO~ <br /> <br />REMARKS: AUTH <br /> <br />DONALD E. WOODLEY, HARION COUNTY BUILDING OFFICIAL / 8Y <br /> <br />OFFICE COPY <br /> <br /> <br />