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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 />of a registered builder, <br /> <br />Other_ <br /> <br />O~NCA"fE: 0472q/92 T1ME; q?:'08='12 <br /> EMERY, ADRIAN <br /> <br />RES1 DEN/' IAL <br /> <br /> ' 6b~i~:Ci'FY: UGB: , OCCUPANT LOAB: <br /> 435 NORTH SANI'iAM HWY <br />DE'I'ROI 'l' OR 9?342 <br /> DE1'ROi'T NO ' <br />USE OF BUILDING'. <br /> <br />MAILING ~DDRESS; .... <br /> <br /> 6717 '14']'H AVE <br /> KEIZER OR 97303 <br /> PHONE: 390-1137 <br /> <br />LOT: :BLOC~: :~ECfION; ~OWNsNiP: <br /> <br /> SIv'm~b.L L.ANE :'~:RACF ~t0 <br /> <br /> SI'1'E NUMBER: 92-01557 <br /> ~ANG~AI'~UA:~ ION "' ~26N6 <br /> MAP: <br /> <br />10'i~. imm: '5'E ,CORNE~: ~ <br /> <br />YES NO <br /> <br />PER~t'f OR APPLiCA'i"iON NO: 9039493 <br /> <br />CON'TRACTOR, NO. 36421 <br />KEVIN'S BACKHOE <br />P O 8OX 4,65 <br />OE1'ROiI',PHONE; 9?342-0000 <br /> <br />WA'IER SUPPLY; CW <br />TEST HOLES REAOY: <br />SiTE EVALUA'rION NUMBER; 2905? <br />EXiSTiNG TANK SIZE: <br />EXiSTiNG DRAIN FIELD LINES; <br />~EP'T'IC 'TANK PUMPED: <br />PREWIOUS NO. BEDROOMS: <br /> <br />.... ....................... ..................... 8GZ TTT? <br />SEE:PAGE TRENCH X, / 1 $210,00 <br /> / 'TOTAL ~SE~ED FEES $210,00 <br /> PREVIOUS RECEIPTS $0.00 <br /> TM.tS RECEIPT $2!0,00 <br /> <br />BALANCE DUE $0 , O0 <br /> <br /> PAYEE: KEVIN~f$ BACKHOE iNVOICE NO: 41559 <br /> RECEIVED BY: c"l TYPE: iN CHECK ~; <br /> <br /> SEE A'T"IACHED ~CUM~'f' FOR RE~iR~EN'FS OF ON-SITE SEWAGE SYSTEM, <br /> <br />* THiS i~ NOT A PE~iT. THIS APPLi~Ti~ ~T ~ TH~ A R~I~ P~E~ ~RE THE <br />FOLL~ING ~T Bg ~PL~T~O. iT iS THE R~I~iLiTY OF TH6 APPLIC~'F TO ~RE THAT <br />ALL N~CE~ 1NFO~TI~ H~ B~ P~IDED. <br /> <br />PLAN REVIEW: BY <br /> <br />REMARKS PERMIT <br /> <br />DA 'T' E ................................................. <br /> <br />CITY JURiSDiCTION: 8Y DA'IE <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 R~V, 4/90 <br /> <br /> <br />