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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 performin9 work on a property I own or occupy. <br /> <br />SIGNATURE OF APPLIGANT: <br /> <br /> DATE: 05/17/9;~ TIME: <br />OWNERz <br /> <br /> BABEF~, ])AVID & JANET <br /> <br />18~ 3~): i8 <br /> <br />fAX LOY: <br /> <br />CONSTRUCTION TYPE: <br /> <br /> A U M!:~ V I L.l_i']; <br /> <br />SSE OF BUILDING: <br /> <br />MAILING ADDRESS: <br /> <br />8649 SHAW .SQUARE RD ,,SE <br /> 97%25 <br /> <br />CONTRACT CITY; UGS; <br />MARION C(,)UN]'Y NO <br /> <br />CATEGORY; <br /> <br /> R Iii; 91 D E N T 1[ A I.,. <br />OCCUPANCY: <br /> <br />SITE HUNBER: 9;~-~1705 <br />VAI,..UATI ON;: <br /> <br />'OCCUPANI LOAD: <br /> <br /> PH~NE: 588-8155 <br /> <br />LOT; BLOCK: SECTION'. TOWNSHIP; RANGE; ZONE'. MAP: <br /> <br /> :L;~ 8S ,R~. Lb+: ~0~: 49 <br /> W~DTH: DEPTH: AREA: ONITS; <br /> e. :L N0 N0 <br /> <br />TYPE: OH-SITE SEWAGE <br /> <br />PERMIT Ol~ APPLICATION t40: <br /> <br />OI lRAl,,lOk, ILO,. 04164 <br />AdolI~,h H Scl~arf'l" <br />15~ [,ordon Rd NE <br /> <br />PHONE: <br /> <br />9~47146 <br /> <br />WATER SUF'F'LY: PW <br />TEST HOLES READY,", <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: 506 <br />EXISTING DRAIN FIELD L,[NES: <br />SEPTIC TANK PUMPED: <br />PRE¥,'[0US N0. BEDR00M!:i: <br /> <br />I TEi'l QUAN'I' I 'fY AMOUNT <br />REPAIR .- MINOR 1 $85,.08 <br /> <br />TOTAL ASSI--b;.SED FEES <br />PREVIOUS RECEIPT9 <br />THIS RECEIPT <br /> <br />$85.00 <br /> $0.00 <br />$05.00 <br /> <br />BALANCE DUE $0.00 <br /> <br /> F'AYEE. Ado,LpJn H Sci~"'I"'l~ RECEIPT NO: 49400 <br /> RECEIVED BY: PM l'y~'. .... <br /> ....................... , ...................................................................... ~ E,. CA L. Hh&K :IL, <br /> SEE ATTACHED DOCUMENT FOR REQUIREMENTS OF 0N-SITE SEWAGE SYSTEM. <br /> <br /> * THIS IS HOT A PERHIT. THIS APPLICATION HUST ~ THROUSH A REVIEW PROCESS <br />FOLLOWING HU~'I' BE CONPLET~I). IT IS THE RESPONSIBILITY OF THE APPI.,.~CANT TO ASSURE ~';' <br />ALL N.:CEoSARY INFORNATION HAS BEEN PROVIDED. <br /> <br />REMARKS: REP: i'4Ii,] <br /> <br />6ITY JUI~IS])TC"I'iON: BY <br /> <br />DATE ............................... <br /> <br />FORM ~ MC 15-56 REV, 4/90 <br /> <br />OFFICE COPY <br /> <br /> <br />