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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONB: .588-514'7 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />OWNER: I)ATE." 02/2'. ..~/¢,~ <br /> <br /> LOF'DAHL., I,.,OLf I SIE <br />SITUS ADDRESS: <br /> <br />TAX LOT: <br /> <br />CONSTRUC"fON TYP[: <br /> <br />OATEGORY: <br /> <br />o~S~,~N'T' I Al-. <br /> <br /> 12122 FRY f~OAD <br />AI.IRORA <br /> <br />MAILING ADDRESS: <br /> <br /> , 'Cd~'~h^8~ C'~¥'/: u~u: <br /> NE <br />OF: 9~02 ! i4AF<!I:IN COUN'rY~ Ii <br /> <br />SUBDIVISION: <br /> <br />OCCUPANT LOAD: <br /> <br /> NO OF BEDROOMS <br /> <br />LOT: <br /> <br /> 378-2380 <br />BLdCK; <br /> <br />TowNgHIP: <br /> <br />VALUATION: <br />RANGE: ZONE~ <br /> <br />MAp: <br /> <br />WIDTH: <br /> <br />DEPTH: <br /> <br />ABe~.- U~rf¢S ~: LOYi : 66~i~J <br /> ,,5. AC, YF'R : NO,,, <br /> <br />TYPE: ON-SITE SEWACE <br /> <br />PERHiT OR APPLICATION NO: <br /> <br />CONl RAC f (,;I,',.~ NO,, <br />LOFOAHI.,,~ <br /> <br />?945482 <br /> <br />WA"fER 81JPPLY <br /> <br />EXISTZN6 T~NK S~ZE: <br />EXISTING ~RAIN FIELD LILIES: <br />SEPTIC TANK PUHPEI): <br />PREVIOUS NO. BEI)RO0~S: <br /> <br /> QUAN'¥'ITY <br /> ANNUAL E'~¢AL,. - TEttF' OR HDSHP MH <br /> <br /> TOTAL ASSESSE~ F'E'ES <br /> TH~S RECEIPT ' <br /> BALANCE DUE <br /> PAYEE: LOFI)AHL, LOUISE RECE'[P" NO: <br /> RECEIVED <br /> <br /> SEE ATTAI]HEI) ~OCUHEI,IT FOR r~EQU:[REHEMTS OF ON-SITE SEWAGE SYSTE.I. <br /> <br /> ~ THIS IS NOT A PER~IT. THIS APPL CATI <br /> <br />fiLL NECI~:SS~RY INFOI~fiT~I)N <br /> <br />R~iHAI'd(8:: HI)SP I;~EI,It!'~JAL. <br /> <br />CTI'y JUR:[S:D]:CI'ION~ BY <br /> <br />,o~ ,~ MC ~.~, R~V. ,~,0 OFFICE COPY <br /> <br /> <br />