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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 ~ / L~''' <br /> 220 HIGH STREET NE <br /> SALEM, OREGON 97301 ~ ,~F ~lll~ <br /> PHONE: 588-5147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> B~GNATURE OF APPLICAN <br /> <br /> BATE: <br /> <br /> of a registered builder. <br />( ) The work will Be performed by 8 registered builder. <br />( / Other <br /> <br /> DATE: J, 2/1 Z/?2 TIME: <br />OWNER: <br /> DANI_E, ELDEN }_ & .SHAROh <br />SITUS ADDRESS: <br /> <br />i1:40:40 <br /> <br />RESIDENTIAl <br /> <br /> 10908 SIMPSON <br /> AUMSVILL. E <br /> <br />USE OF BUILDING' <br /> <br />~OAD <br /> OR <br /> <br />CONTRACT CiTY UGB OCCUPANT LOAD <br />MARION COUNTY NO <br /> <br /> ~0 OF BEDROOM.~ <br /> <br />SUBDIVISION <br /> <br />PHONE: 393-7734 <br /> <br />SITE NUHGER: ~2-04275 <br />VALUATION: <br /> <br />I,OT BLOCK. <br />WIDTH; OEP'TH <br /> <br />SECTION <br /> <br />AREA <br /> <br />TYPE: OR-SITE SEWAGE <br /> <br />PERNIT OR APPLICATION NO: <br /> <br />CON'FRACTOR~ NC. <br />OAHLE. ELDEN D & SHARDN <br /> <br />PHONE: ~9~.-7734 <br /> <br />46. <br /> <br /> 8S ] w E, FtJ <br />UNITS RREG. LOT CORNER' <br /> AC ES NC <br /> <br />90444~7 <br /> <br />WATER SUPPLY: P~ <br />TEST HOLES READY' <br />SITE EVALUATION ~UNBER: 8523 <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIEL[) LINES: <br />SEPTIC T~NK PUMPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM QUANT I TY AMOONT <br /> STANDARD ON-SITE SYSTEM I $21(, <br /> <br /> TOTAL ASSESSEO FEES $._10.. 0{'? <br /> PREVIOUS RECEIPTS SD.O0 <br /> THIS RECEIPT $2].0_00 <br /> <br /> BALANCE DUE $~ Od <br /> <br /> PAYEE: OAMLE .EL. DEN O. & SHARON RECEIPT NO: 46620 <br /> RECcIVED BY: CL TYPE; CK CHECK ~: .190D <br /> <br /> SEE ATTACNED DOCUMENT FOR REQUIREMENTS OF ON-SITE SENAmE SYSTEM. <br /> <br />* THIS IS NOT A PERMIT. THIS APPLICATION NUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLL, ONING MUST 8E COHPLETEO. IT IS THE RESPONSIBILITY OF TNE APRLICANT TO ASSURE <br />ALL NECESSARY INFORMATION HAS BEEN PROVIDED. <br /> <br /> k <br />PLAN NEVIEN: ....................................... <br />RiMARKS: ST,, BY"~/'~---~'~-- DATE_..._/~_/¢_.?__. CITY J'URiSOICTION: BY DATE <br /> ; / <br /> <br />FORM # MC 15-56 REV, 4/90 OFFICE COPY <br /> <br /> <br />