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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STR'EET 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 g property I own or occupy, <br />I anl a reglstored builder OR ( ) the authorized representative SIGNATURE OF APPLICANT: <br />of a registered builder. <br />The work will be ¢erforpned by a registered builder, <br />Other <br />I i~ave read 8nd agree to the terms staled on the reverse side of DATE: <br />this document. <br /> <br />OwN~A'f'E; 05/12./92 f:IME: 15:58:'14 ¥~XLbT: <br /> <br /> OVE~ON, RICHARD & Sf'tIRLEY 56501"909 <br /> SITUS ADDRESSI CONSTRUOYION ~ryPE: <br /> <br />CATEGORY: <br /> <br />OCCUPANCY; <br /> <br />RESiDEN]'IAL <br /> <br /> 11937 CAUSEY LANE <br /> AUtv~v Y LLE <br />USE OF ~UILDING'. <br /> <br /> iO~CTOITY: <br /> SE <br />OR 97325 <br /> FffARION COUNTY NO <br /> <br />;OCCUPANT LOAD: <br /> <br /> NO OF BEDROOMS: <br /> <br />3 <br /> <br />SAME <br /> <br />PHONE: 769-40T9 SITE NUtVlBER: 92-01809 <br /> ' ~ALUA'['~ON: <br /> <br />MAP: <br /> <br /> DEPTH AAE^i 33 :UNITS: 8S IRREG. LOT tN CORNE~: AR <br />W{DTH: <br /> <br /> 25'] 260 6785.0_.. ' SF: NO <br /> <br />48 <br /> <br /> TYPE: ON-SI'T'E SEWAGE WATER SUPPLY: PW <br /> TEST HOL~ READY: <br /> PER~Z'T' OR APPLICATION NO: 903992? St'f'E EVALUATION NUMBER: <br /> E×tSTING TANK SIZE: <br /> CONTRACTOR, NO. EX[S'T'ING ORAiN FIELD LINES: <br /> OVERSON, RICHARO A ~iRLEY ~EP'FIC 'f'~K <br /> ~E PREVI~S NO. BED~S: <br /> <br /> PHIL: 769-40?9 <br /> <br /> REPAIR -- ~JNOR /~2 ' I $70,00 <br /> TOTAL <br /> ASSE~ED <br /> FEES <br /> PRbWZ~8 RECC1P1'S $0.00 <br /> <br /> PAYEE: OVERS~, RICHARD & ~IRLg~ RECEIPT NO: <br /> RECEIVED aY: ~ TYRE: CK C~ECK ~; 399 <br /> <br /> SEE A'I"FA~ED D~MEN'f' FOR REdIReCTS OF ON-SiTE SENSE <br /> <br />~ THIS IS NOT A PE~iT. THiS APPLI~T~ ~5T ~ TH~ A RBi~ P~B ~ERE THE <br />FOL~[N6 ~ST BE ~PLETED. IT IS THE R~S[B[L~TY OF THE APPLI~T TO ~RE THAT <br />ALL N~ iNFO~Ti~ H~ BE~ P~V[DED. <br /> <br />REIVC, RKS: SEP1'IC I'ANK REPAIR <br /> <br />DATE <br /> <br /> OFFICE COPY <br />FORM # MC ~ ~-5~ REV. 4/90 <br /> <br /> <br />