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MARION COUNTY BUILDING INSPECTION <br />SENATQR BLDG. NO, 225 <br />220 HIGH STREET NE <br /> SALEM, QREGON 97301 <br /> <br /> PHONE: 588-5147 8:00- 4;30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 ~ <br />)&'~l am a registered bander OR the authorized representative S GN^TURE OF ^APL CA~¢~..,~..(' '"'"~ ..~- ;- .-, <br /> <br /> OATE: 09/14/72 ~IME: <br /> <br /> KLEIN, LARRY <br /> ~ 56401000 , RESIDENTIAL <br />'SITUS AD¢~SS~ ~( OON~TRUGTION TYRE'. ~ OCCUPANCY'. <br /> 9784 H~LL CREEK RD SE ,,'Cd~X6f'b-f?J <br />' AUMSVILLE OR 97~25 ~MARION COUNTY ~ NO <br /> <br />LOT: <br /> <br />W~DTN; <br /> UNITS; <br /> I ~. AC NO ~ NO <br /> <br />9804 MILL CREEK RD SE ........... <br />AUMSVILLE, OR SITE NUMBER: <br />PHONE: 749-2405 VALUATION: <br /> <br /> AREA <br /> <br />TYPE: PLUMBING PERH~T OR APPLICATION NO: <br /> <br />CONTRACTOR. NO. <br />KLEIN~ LARRY <br />9804 MILL CREEK RD SE <br />AUMSVILLE, OR <br />PHONE: 749-2405 <br /> <br /> ITEM <br />WATER LINES, 1BT 100 FEET <br />SEWER LINES~ &ST lO0 FEET <br />PLUMBING STATE SURCHARGE <br /> <br />9042510 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DUE <br /> <br />QUANTITY AMOUNT <br />1 $20.00 <br />1 $$0.00 <br /> $2.50 <br /> <br />$52.50 <br /> $0.00 <br />$52.50 <br /> <br />$0.00 <br /> <br /> PAYEE: <br /> KLEIn,~ LARRY RECEIPT NO: 44577 <br /> RECEIVED BY. cl <br /> ........................ TYPE: OK CHECK ~: 1061 <br /> <br />* THIS IS NOT A PERMIT. THIS APPLICATION HUBT GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE CONPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />LL NECESSARY INFORMATION HAS BEEN PROVIOED. <br /> <br /> PLAN REVIEW: BY .......... DATE ............ CITY JURISDICTION: 8Y ........ DATE <br /> REMARKS: < lO0 FT EA FOR WL , SL <br /> <br />FORM # MC 15-56 REV, 4/~0 OFFICE COPY <br /> <br /> <br />