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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 />lam a registered bullderOh( ) the authorized representative <br />of a registered builder, <br />The work will be DedOrmed by a registered builder. <br />Other_ <br /> <br />have read and agree to the terms stated on the reverse side of <br /> <br /> DATE: 11/09/92 TIME: ,!.0:23:49 <br /> OWNER'. '?A~ FO'Cf ; GATe. GORY; <br /> GUSTAFSON, C~RL 90250-325 RESIDENTIAL <br />]SITUS ADDRE ' '~f~'O~flON fV~E~ OCCUeANCY: <br />  "~ ' O¥~TR~C~ O]~Y; 'OG~: OCCUPANT <br /> OR 97~42 DETROIT ~ NO . <br /> <br /> SiTE NUMBER: 92-0~895 <br /> PHONE: V~LU~T[ON: <br /> <br /> 2 ~ ....... ~ ......... ~0 ' 5E RS ~05 <br /> 90 100 9000. SF ' NO NO <br /> <br />TYPE: ON-SITE SEWRGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />GUSTAFSON, CARL <br /> <br />RHONE: <br /> <br />WATER SUPPLY: <br />TEBT HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING ORAIN FIELO LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NOi BEDROOMS: <br /> <br /> ITEM QUANTITY AMOUNT <br />SITE EVALUATION, FIRST LOT 1 $2,20.00 <br /> <br /> TOTAL ASSESSED FEES $220.00 <br /> PREVIOUS RECEIPTS $220.00 <br /> THIS RECEIPT $0.00 <br /> BALANCE OUR $0.00 <br />PAYEE: INVOICE NO: <br />RECEIVED BY: PB TYPE: CHECK ~f: 0 <br />SEE ATTAOHEO DOCUMENT FOR REQUIREMENTS OF ON'-SITE SEWAGE SYSTEM. <br /> <br />NOTE: THIS DOES NOT GRANT OR IMPLY PERMISSIOM TO BUILD ON THIS PARCEL. PLANNING AND <br />ONSTRUCTION PERMITS MUST 8E OBTAINED BEFORE BUILDING OR SEPTIC INSTALLATION 8EGINB~ <br /> <br />REMARKS: SE -, OKAY FOR A TWO 8EOROOM MAXIMUM RESIDENCE-STD SYSTEM <br />OONALO E. ~000LEY, MARION COUNTY BUILDING OFEICtAL / BY ............ ~,,~../?__ ......................... <br /> <br />~ORM ,~ MC ~-~ ney. 4~o OFFICE COPY <br /> <br /> <br />