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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. NO. 225 <br /> 220 HIGH STREET NE <br /> SALEM, OREGON97301 ~ ! L E <br /> PHONE:588-5147 8:00- 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 .~ ~ . <br /> <br />~ ~1 a reg_ s e ed builde OR f ho authorized rt:presentati~o SIGNATURE OF APFLICANT:~~ ~2~,m_ <br /> <br />The work Will be performed by a recj stered builder, <br />Other. <br /> <br />OWNER; DATE.' 0,5/25/93 <br /> <br />SITUS *D~E.~fUSHEZ~ DAN <br /> <br /> 100~:1. ARNDT RD NE <br />uss oF eu,~ot~!RORA OR ~7002 <br /> <br />CONTRACT CITY'. UGS: OCCUPANT LOAD: <br /> <br />MARION.COUNTY: NO <br /> <br />TYPE: OH-BITE SEWAGE <br /> <br />PEAHIT OR APPLICATIOH NO: <br /> <br />CONI'~ACTOR. I,iO. 3~966 <br /> BOB~S ;SACEHOF~ <br />,1.7004 ARBOR GROVE R~ NE <br />WOODBURN~ 97871 <br />PNONE: 9S1-I28~ <br /> <br />?047297 <br /> <br />WATER SUPPL'(: PW <br />TEST HOLES READY: <br />SITE EVALUA'flON N[JHBER: <br />EXISTING TANK SIZE: <br />EXISTING ~AIN FIEL~ LINES: <br />SEPTIC TANK PO~IPE~ <br />PRE¥IOUS NO. BEDROOMS: <br /> <br /> ITEM QUANTITY ANOUN'f' <br /> AL'I'ERA'F;[ 0,~1 I $2~;5,00 <br /> <br /> TOTAL ASSESS'ED FEES ~"~ '~' <br /> PREVIOUS RECEIPTS $~,, ~¢ <br /> THI~ RECEIPT %"~,¢,¢. ~¢ <br /> <br /> EALANCE PUB $~,. ~0 <br /> F'AYEE: MARTUSNEZ~ QAN RECEIPT NO~ 4~558 <br /> RECE.LVED ~Y: PH TYt E. CK CHE. t.,K ~: 24~ <br /> <br /> CEE ATTACHED ~OCL)MEHI' FOR REQUIF(E~ENT~ OF ON-SITE SEWAGE SYSI'gM. <br /> <br />POLLOWZNG MUST BE COMPLETE~. ['f' IS THE RESPONSIBILITY OF THE AF'F'L. ICANY TO ASSURE: THAT <br />ALL NECESSARY ]:NFORMA'T'ION HAS ~EEN PROVIDED., <br /> <br />REMARI<S: ALTERATION <br /> <br />CYfY JURIS:OIC, TION: DY ..................DATE .............................. <br /> <br />OFFICE COPY <br /> <br /> <br />