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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> am pe Orm ng work on ~ property IOWn or OCOupy. . <br /> l am a registered builder OR ( )thesuthorized ropresentabve <br /> of a registered builder. <br /> The work will be performed by a registered buildor, <br /> Other , <br /> { have read and agree to the terms stated on the roverse side of <br /> this document. <br /> <br /> BATE= 07/24/~:~ TIME: lS:~9:2~ <br />OWNER'. <br /> RAUSCHER, NORMAN & CAROL <br /> <br />SfTUS ADDRESS'. <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />71050-130 RESIDENTIAL <br /> <br /> 11481 STEINKAMP RD SE <br /> AUMSVILLE OR 97325 <br /> <br />USE OF BUILDING; <br /> <br />MAILING ADDRESS: <br /> <br /> ~05 W. REGIS ST <br /> STAYTON OR 97383 WK~378-8486 <br /> PHONE: 769-2092 <br /> <br />LOT: 8LOC~. SECTION~ TOWNSHIP; <br /> <br /> 8 <br /> 2 29 8S <br />WIDTH' ; :bE~N : ........................................... AREA UNITS <br /> ~01 ! 727 218827. <br /> <br />SU BGIVISION <br /> <br /> DZTTER HILLS <br /> <br /> SITE NUHBER: <br /> VALUATION: <br /> <br />OCCUPANT LOAO' <br /> <br /> NO OF BEDROOMS <br /> <br />92-02755 <br /> <br />1W AR 48 <br />RREG. LOT; CORNER <br />NO NO <br /> <br />TYPE: ON-SITE SE#AGE <br /> <br />PEEHIT OR APPLICATION <br /> <br />CONTRACTO~ N0..02145 <br />Eddie L WzIson <br />4077 State $~ <br />S8[em, ~7301-5486 <br />PHONE: 399-1134 <br /> <br />9041505' <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM <br />STANDARO ON-SITE SYSTEM <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY AMOUNT <br /> 1 $210.00 <br /> <br />$210.00 <br /> $0.00 <br />$210~00 <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: Eddie L Wilson <br />RECEIVED BY: PW ......................... <br /> <br /> RECEIPT NO: 43558 <br />TYPE: CK CHECK ~: 3192 <br /> <br /> SEE ATTASHED DOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br />* THIS ~S NOT A PERMIT. THIS APPLICATION MUST ~0 THROUGH A RE¥IE~ PROCESS WHERE THE <br />FOLLOWING MUST BE COMPLETEO. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORMATION HAS BEEN PROVIDED. <br /> <br />PLAN REVIEW: BY .......... DATE ............. CITY JURISDICTION: BY ......... DATE .......... <br />REMARKS: NEW INSTALLATION <br /> <br />OFFICE COPY <br /> <br /> <br />