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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 />L <br /> <br />I am a registered builder OR ( the authorized rec, resen~ative <br />of a registered builder, <br />The work will be performed by a registered builder. <br />Other <br /> <br />:l. ]. 0 J(][ J'~i~IEY , .... CONTRACT CITY; I UGB; OCCUPANT LOAD: <br />~)!E'f'RO:[T OR ?7;42 ~ I)~ETRO:~T ~ N~ ', <br /> <br /> , <br /> <br />F.[,. BOX 597 <br />I)~;IkO,[l,, Ok , SITE NUf~BER: <br />~]IONE. 8.,4-2275 I VALUATTON: <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT BR APPLICATION <br /> <br />CONTRACTOR,, <br />KEVIN'~0 BACKHOE <br />PI BOX 46,5 <br />~ETROi'I'. <br />Id-lONE: 854,--~7~7 <br /> <br />90477~6 <br /> <br />WATER S[JPF'LY: CW <br />TEST NOLES READY: <br />SITE EYALU&TION NUMBER: <br />EXISTING TANK SIZE: <br />EXI~TIN6 ~RAtN FIEL. B LINES: <br />SEPT]:C TANK F'UNPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> :I;-¢'E~ QUANTITY AMOUN'Y' <br />¢ ,-TERA'¥IOi,I I $25!% 00 <br /> <br />TOTAL ASSESSED FEES <br />PREVTOUS kECE,1. F T,9 <br />THIS RECEIF'T <br /> <br /> BALANCE DUE <br /> <br /> ~ -" ' '' ][NVO][CE' NO: 58024. <br /> ~AYEE. KEVIN'S BACKHOE <br /> RECEIVED [~Y: PM TYPE: IN CHECK ~:: <br /> SEE ATfA ,HED DOOUMEI,tT FOR RE~U]:RE~tEN'fS OF OH-SITE SEWAGE <br /> <br /> Z THIS IS NOT A PERHIT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />EOLLOWZN[; MUST ~Ed~Z CGHrLETE~ .... ZT IS THE RESPO,~ 8IL:[TY OF THE APPLICANT 'T'O ASSURE THAT <br /> <br />ALT --. NOTE: ,'MI';~ ASSES~JSxSF,:'¢ !'~ MAP <br /> <br />C;[TY JL.IRI,~D]:C'fl[ON. BY ............................. DA'rE ............................ <br /> <br /> <br />