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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 properly I own or occupy. <br />I am a registered builder OR the authorized representative <br />of a registered builder. <br />The work will be performed by a registered builder. <br />Other__ <br />I have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br /> ow~ E~.'I:E = 05/'29/92 TIME: 9:20.'26 <br /> ; TAX LOT[ <br /> <br />, TAUTF~T, ~ELL UN~O~ C~ <br />~ITUS <br /> OOCUPANOY; <br /> <br />: 11371 FARGO R0 NE '~ON'r~AE'r 8 TY ,' 'ud~': iOCCUP^NT LOAD: <br /> AU F, tYJ RA OR 970B2 <br />use OF E~U~LmNe: NO <br /> <br />:MAILING ADD~§S'. '"' '"" 'SUBOIVISION; .............. <br /> <br />2175 5TH St ................ <br />HUBBARD OR 97832 <br />I PHONE: 981-3074 SITE NUIV)BER: 92-01622 <br /> VALUATION: <br />LOT: : BLOCK~ S~CTION; TOWNgHIP: : RANGE; ZONE; MAP: <br /> <br /> , 05 ,, 4S ' , ],W,,,, EFU 4 <br /> 2.751 AC NO~ NO <br /> <br />TYPE: ON-SII'E SENAGE <br /> <br />PEFU~qtl' OR APPLICATION NO: 39608 <br /> <br />CO~TRAC'FOR~ NO; <br />'FAU'FF~'F, <br />3175 5TH ST <br />HUBBARD OR 97032 <br />PHONE~ 98~-3074 <br /> <br />HATER SUPPLY: P~ <br />TP_,.~ST ROLES READy: YES <br />SiTE E~FALUAI'iON NUP4BER: 33867 <br />~iSTING 'F~K SIZE: <br />~ISI'ING D~iN FIELD LINES: <br />SEPTIC 'F~K ~ED: <br />PR6Wi~S NO. BED--S: <br /> <br /> i T E.tfl (.~.JAN 'r i 'FY AIV)OU N 'f' <br /> SAND FILTER 1 $355.08 <br /> 'tOTAL AS!:i~EO FE¢'~ $365.00 <br /> PRB¥iCUS RECEIPTS $385.00 <br /> THiS RECEIPT $0.00 <br /> <br /> BALANCE DUE $0.00 <br /> PAYEE: RE%EiPT NO.* <br /> RECEIVED BY: F~ TYPE: CHECK ~: 0 <br /> <br /> SEE ATTACHED DOCUMENT FOR REQUiREr4ENTS OF ON-SiTE SEINAGE SYSTEIVl. <br /> <br />~ THI,.$ ISA VALID PERI~T * THI,~ PEt:~,[T EXP~RI~ 360 DAY~ PROIVl iTS I~,_<~E DATE. Il= <br />CO~STRLICTION I=Ai'L~ TO ~ ALL Rli~t~EI~ENTS OF STATE LA/¢~ AND I~",ARION COUNTY BUILDING AND <br />7.-ONfNS OR~I~M*IOE~. TH.tS PEI~,[T ~,-IALL S~E NULL AND <br /> <br />REf,IARKS: S~D FiLl'ER SYSTET,1 <br /> <br />DONALD E+ I/~ODLEY, fft'~,R'FON COUNTY BUiLDiNG OFFICIAL / BY <br /> <br />FORM # MO ~5-56 REV, 4/~)0 OFFICE COPY <br /> <br /> <br />