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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-514'/ 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 />I arr~ a registered builder OR the authorized representative <br /> of a rerstered builder, <br />The work will be performed by a reDistered builder, <br />Other <br /> <br /> I have read and agree to [he terms stated on the reverse side of <br /> this document <br /> <br /> DATE: 12/29/92 TIME: 11:04;27 <br />OWNER; <br /> DUNCAN, JAMES E & DOROTHY Y <br /> <br />SITUS ADDRESS: <br /> <br />TAX LOT CATEGORY: <br /> <br />CONSTRUCTION TYPE <br /> <br />OCCUrANC¥ <br /> <br /> 9033 W STAYT'ON RD SE <br />AUHSVILI._E OR 97523 <br /> <br />~(~,~. ~S,"(~ijNT L~(l~: OCCUPANT LOAD <br /> <br />USE OF BUILDING: <br /> <br />SUBDIVISION: <br /> <br />S <br /> <br />SAME <br /> <br />PHONE: 749'~154S <br /> <br />SITE NUMBER: 92-04365 <br />VALUATION: <br /> <br />LOT; SLOCK: SECTION; <br /> l <br />WIDTH: DEPTH: : AREA; <br /> <br /> 2W E'FI <br />UNITS BREG. LOT CORNER <br /> AC YFL~ NO <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERHIT OR APPLICATION NO: <br /> <br />CONTRACTOR. NO. <br />DUNCAN, JAMES E & DOROTMY Y <br />SAME <br /> <br />PHONE: 749-~B45 <br /> <br />90446~8 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVAL_UATION NUMBER; <br />EXISTING 'TANK SIZE: <br />EXISTING DRAIN FIELD LINES; <br />SEJJTIC 'rANK PUHPED: GVN FDR~t <br />PREVIOUS NO~ BEDROONS: 4 <br /> <br /> I 'I'EM QUANTIIY AMORNI' <br />AUTBORI'ZATIDN NOr'ICE ,- FLD. VISt'F i $1,:~0.,)) <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THiS RECEIPT <br /> <br />$ .I.5 D _ OR <br />5/3D. DO <br /> <br /> BALANCE DUE $0.o0 <br /> PAYEE: DUNCAN, JAMES R & )OROI"IY Y (~ '~ REC;:"rpj' wn- ,~-/:'~ <br /> RECEIVE) DY' DM2 ~l TYPE DK ] ""'X" ; ..... <br /> - -: ..... ::- ....................... :,:! .............. i L:. ,,, ~J,L,. ,,, ~ ~ ?.( <br /> SEE ATTACHED DDCUHENT FOR REQUIREHENTS OF ON-SITE SEWAGE SYSTEH. <br /> <br />· THIS IS NOT A PERMIT. THiS APPLICATION MU~T GO THROUGH A REVIEW PROCE88 WHERE THE <br />EOLLONING MUST GE COMRLETED, IT I~ TBE RESPONSIBILITY OF TNE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORHATION NAS SEEN PROVIOED. <br /> <br />RE'.NARKS: SEPT'lC AUI'H <br /> <br />OFFICE COPY <br /> <br /> <br />