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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 oco <br />[ &ma ¢o9istered builder OR tho authorized representative S GNA%URE OF APPL CANT: ~ <br /> a registe.red buildof ~ ' ~ ¢ ' /~'~4~-~ <br />Other. <br /> / <br />, nave reod and agree to the terms stated ontho roverse side of ~ATE; ~--/~--' <br />this document. . <br /> <br /> DATE: 05/].:1,/9;.~ TTME: 12:;04:46 <br />OWNER: TAX LO~: CATEGORY; <br /> GODFREY, EF(NEST 75:};00780 RESIDENTIAL <br />~TUS ADDRESS: CONSTRUCTION TYPE: OCCUPANCY: <br /> <br /> 88~4 ,.~I-IAW OQUARE RI) SE ~O~RA~TCII'Y U~g: OCCUPANT LOAD: <br /> AOS~VILI..E OR 97~.,.u~ ~ARION COLINTY I,lO <br /> <br />USE OF BUILDING; <br /> NO O~ 8EORO0~S: <br /> <br />MAILING ADDRESS: StJ BE)I~I~iONi <br /> <br />SAME <br /> SITE NUHBER: <br />PHONE: YAL,.UATION: <br /> <br /> 24 :F3$ 2W AR;~ 51 <br /> '.1. r/.I 19 1077 10~74~3. SF NO YES <br /> <br />TYPE: ON-S~- ~43~;JAGE ~ WATER SUPPLY <br /> ~ r ~.. ~ ]~EST HOLES READY: <br />PERMIT ~R APPLICATION HOc ~ 47818 ~SITE EVALUATION NUMBER: <br />~ -- ~ EXISTING TAbK SIZE: <br />CONTRACTOr!~ <br />60~FREY,, ERNEST <br />SAME <br /> <br />PHONE: <br /> <br /> 1888 <br />EXISTZNG DRAIN FIELD LINES: <br />SEPTZC TANI( PUMPED: <br />PREWOUS NO. BEDROOMS: 2 <br /> <br />500 <br /> <br /> ITEM QUANTITY AMOUNT <br /> AUI'HOI;:IZATION NOTICE -- FLD. VISIT 1 $160.00 <br /> TOTAL ASSESSED FEES $;I, 60,,0~ <br /> PREVIOU,~ RECEIPTS $~. <br /> THIS RECEIPT <br /> <br /> BALANCE DUE $~,. <br /> ~AYEE: GODFREy, ERNEST RECE]:~'.[ NO: 4926~ <br /> RECEIVED BY: [,L I'YPE:~ CHECK ~: ].447 <br /> SEE ATTACHE~ O06UHENT FOR REOUZREHENTS OF ON-SITE SEWAGE SYSTEN. <br /> <br /> ~ THZS ~S A VALI~ PERH~T · THI~ PERmiT EXPIRES ~8 BAY~ FRO~ ITS ISSUE ~ATE. IF <br />CONSTRUCTION FAILS TO MEET ALL REQUIREMENTS OF STATE LAWS AND NARION COUNTY BUILDING AND <br />ZON:[N6 OROlWANCES2 T~;~ PERMIT SHALL. BECOHE NULL ANQ VOI~. <br /> <br /> REMARKS,, AUTH <br /> <br /> ~ONALD E,, WOODI_EY, MARION COUNTY [40ILDING OPFrICIAL / BY <br /> <br />FORM tf MC 15-$G REV, 4/90 OFFICE COPY <br /> <br /> <br />