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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 authorized representstNe SIGNATURE OF ARRLICAH <br /> <br />The Work will be pen'~rmed by a registered builder, <br />Other__ <br />have ead and ag eeo he erm~ 88ted on he reverse 8 de o DATE <br />this document, <br /> <br />!OWNER; TAX L? t ~"'~,.-~ ~ ~q~l~OO CATEGORY, <br />: TAUTFEST', RUSSELL -- <br />'~ITUS AbDRE~i I DONSTRUDTION TYPE; OCCUPANCY: <br /> <br />UNKNOWN <br /> <br /> ~ 1371 FARGO RD NE i 8~Rl'F~Ad'r'aif~i ..... i'U~i ...... <br /> ; OCCUPANT LOAD; <br /> AURO~k OR 9?002 : ~ <br /> .................... i ~Ri ~. CQUN'I'Y. ', ~ <br />USE OF BUILOtNG; ~NO OF BEDROOMS <br /> <br />MAILING ADDRESS: SUBDIVISION: <br /> <br /> 31'75 5TH S'T <br /> HUBBARD OR 97032 <br /> PI-lONE: 981-30'74 ~.I;-FE NUMBER~ 92-01622 <br /> VALUA'f' tON: <br /> <br /> 05 4S EFU <br />: i 2, ?5 AC NO i NO <br /> <br />TYPE: ON~Si'¥'E SEWAGE <br /> <br />PERM,('F OR APPLiCA"FiON NO: 9039808 <br /> <br />CONTRACTOR, NO. <br />'f'AU'I'F~'~, RU~ELL <br />3'I75 5FH ~'f' <br />HUBBARD OR 9?032 <br /> <br />SAND FiLl'ER <br /> <br /> WATER SUPPLY: PW <br /> TEST HOLES READY: YES <br /> st'rE EVALUATION NUI'flBERt 3386? <br /> EXIS'FiNG 'rANK S~ZE: <br /> EXISTING ORAiN FIELD LINES: <br /> SEPTIC TANK PGRPED: <br /> PREVIOUS NO, BEDROOMS: <br /> <br /> QUANTI'f'Y AMOUNT <br /> '1 $365_00 <br /> <br />TOTAL ASSESSED FEES $365-00 <br />PREViOUS RECEIPTS $0.0~ <br />THiS RECEIPT $365.00 <br /> <br />BALANCE OUE So.00 <br /> <br /> PA~EE; 'f'AU'f'FEST, RU~,,L RECEtP'f' NO: 4'1850 <br /> RECeiVED BY: ~B *~ TYPE: CK CHECK ~- 058 <br /> <br /> SEE ATTACHE~ DOCU~EN'f' FOR REQUiREmENTS OF ON-SZ'f'E SEWAGE <br /> <br />~ THIS IS NOT A PEI~4IT. THIS APPLICATION NUST GO THROUGH A REVIE~ PROC~5.5 V*tERE THE <br />FOLLC~IiNG MUST BE CO~IPLETED. IT IS TH~ R~3PONSiBILiTY OF 'THE APPLICANT TO ASSURE THAT <br />ALL N~CI~RY INFOR~tATiON NAS BEEN PROVIDED. <br /> <br />PLAN <br /> ..................................... ..... ct'= B= ......................... 0A,' ........... <br /> <br /> REI~ARKS: ~AND FiL'fER SYSTEM <br /> <br /> OFFICE COPY <br />FORM # MD 15-58 REV, 4j90 <br /> <br /> <br />