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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: 588-5147 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 />l am a registered builder OR ( )theauthorizedrepres~ntative <br />of A registered builder, <br />The work will be performed by a registered builder, <br />Other ...... <br />I have read and agree to the terms stated on the reverse side of <br />this document, <br /> <br /> ])ATE: 02/25/93 TIME'-' <br />' OWNER; <br /> BENIOI.~., ]DENNIS & I..OLA <br />SITUS ADDRESS; <br /> <br />:L3~49=44 <br /> TAX LOT: <br /> <br /> ~0220-:~70 <br /> <br />CATEGORY: <br /> <br /> R k. S ;~ [~ E N 'f i A L <br />OCCUPANCY; <br /> <br /> ;(~ E-:'I' ROI T <br /> <br />USS OF BUILDING'. <br /> <br />MAILING ADDRESS: <br /> <br />LOT: <br /> <br />WIDTN: <br /> <br />OR 9'7342 I)r-71'ROIl' i NO <br /> <br />F'O 90X 866 <br />HINES 01:.~ 9?738 <br />F IONL, <br /> <br />:BLOCK: <br /> <br />,OCCUPANT LOAD: <br /> <br /> NO OF BEDROOMS: <br /> <br />TYPE: ON-SITE SEHA~E <br /> <br />PERHiT OR APPLICATION NO: ~455~7 <br /> <br />CON'f RACTOR,~ <br />I~ENTOI% DEI,IN~S & LOLA <br />PO BOX B66 <br />HINES OR ~7738 <br />PHDNE: <br /> <br />WATER SLII~'PL.Y; <br />TEST HI:)I..ES <br />SIlE EVALUATION NUMBEI~s <br />EXISTINg TANK <br />EXIST]:Nf; I)RA:fI,I FIELD <br />SEPTIC T~I,IK PLIHPEI)~ <br />PREV'rOt. IS NO. BED. R(ff.IHSs <br /> <br /> I T E H <br />AUTHORIZATION NOTICE - Fl..[),, VISIT <br /> <br />'TOTAL A=),3E.,)SE.]) FEES <br />PREVIOUS RE(.E,(~ <br />TI-liS RECF~IF'T <br /> <br />QUANT.[ TY AHOUN'¥' <br /> <br />· -$ J. 6~}. 00 <br /> $0,, 00 <br />-$16.('),, <br /> <br />BALANCE i)tJE $0,, 00 <br /> <br />PAYEE: BENTON,, DENNIS & LOLA <br />RECEiYE~ ICY',: CL 4775~ <br />........................ - ............................................................... TYI'I% :iii] I'.l-il;:(,.1s :b,, ~ <br />or-E ATTACHE'b I)OC ~.' ,~ FOR ',E'~ '{~;~';~-~F'-~;~"";';~-;:: .... ;7'X;;;:;:; .............................................................. <br />THIS IS HOT A PERMIT. THIS IS A CANCELLATION D~UHENT. <br /> <br />REMAr4KS: '.CA:NCE[:EAI"~ON OF:"qJM'I'S~UED A~h='blCCiT:'rON <br /> <br />OFFICE COPY <br /> <br /> <br />