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MARION COUNTY BUILDING INSPECTION <br />SEN,,~TOR 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 ownor ocgupy. <br /> l am e 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 ti~e terms stBted on the reverse side of <br /> this document. <br /> <br /> DATE: Q8/27/92 TlltE: 15;58:27 <br />OWNER: <br /> CHASE, ELMER <br /> <br />71050100 i RESIDENTIAL <br /> , OCCUPANCY: <br /> <br /> ,I, 1584 JAMES WAY DRIVE SE i CONTRAC"FOITYz ~UGS: <br />AUNSVILLE OR 97525 !MARION COUNTY! NO <br /> <br />11644 JAMES NAY DR SE <br />AUNSVILLE 97325 <br />PHONE: 749-1410 <br /> <br />/OCPO~ANT LOADZ <br /> <br /> SITE NUMBER: 92-05085 <br /> VALUATION: <br /> <br />TOWNSHIP; i ~ANG~: ~ ~CNS; MAP: <br />[ 8 ~ A E ~ 8 <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERBIT OR APPLICATION NO: 9042191 <br /> <br />CONTRACTOR, NO. <br />CHASE, ELMER <br />~1644 JAMES WAY OR SE <br />AUMSVILLE 97325 <br />PHONE: 749-.1410 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: YES <br />SITE EVALUATION NUMBERs <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPEO: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM QUANTITY AMOUNT <br />SITE EVALUATION, =IRST LOT 1 $22D.DO <br /> <br />TOTAL ASSESSED FEES <br />OREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />¢220_0( <br /> $O.OD <br />$220_00 <br /> <br /> BALANCE OUE SO.DO <br /> CHASE, ELMER i~ RECEIPT NO: 44246 <br />PAYEE: <br />RECEIVED BY: DM .................................. ~ TYPE: OK ~NECK ~: 2331 <br />SEE o'rTACHEO DOCUMEN' FOR REQUIREMENTS OF ON-BITE SEWAGE SYSTEM. <br /> <br />NOTE. 'rHIS DOES NO ORANT OR IMPLY PERMISSION TO 8UILO ON -HIS PARCEL. mLANNING AND <br />ONSTRUCTION PERMITS MUST BE OBTAINED BEFORE BUILDINg OR SEPTIC INSTALLATION BEGINS. <br /> <br />PLAN <br /> BY~_~_.,~__ OATE___~?~_..~./_~_~ CITY JURISDICTION: BY .......... DATE ..................... <br /> REVIEW: <br /> <br />REMARKS: SITE EVALUATION <br /> <br />FORM # MC 15-58 MEV. 4/80 OFFICE CODY <br /> <br /> <br />