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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STI~EET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />avo cad and 8gree otheterrnsstated on the reverse side of <br /> document. <br /> <br />DATE: <br /> <br />OWNER: <br /> <br /> i..ORE ~ DOL)6 I~E8I DEN'I'~:~L. <br />SITUS ADDRESS; ' CONS~RU~TIO~ :~E~ OCCUPANCY: <br /> <br /> :1,:1.704 DIT'fER lr)R <br /> AUMSVTI_LE <br /> <br />USE OF BUILDING; <br /> <br />MAILING ADSRESS: <br /> <br /> SE CONTRACT CITY: ; UGB; <br />OR 97825 MARION COUI,ITY NO <br /> <br />SUBDIVISION: <br /> <br />;!885 SW 224'1'8 <br />HILLSBORO,, OR <br />PHONE',; 649'-7S07 <br /> <br />tOT: BLOCK: sECTION: <br /> 28 <br /> <br /> SiTE NUMBER: 93-81748 <br /> VA ,.,, AT I OI'L <br /> <br /> TOWNSHIP: RANGE; SONE: <br /> <br /> $S ;I.W <br /> UNITS; IRREG. LOT: CORNER: <br />;L. 5 AC NO NO <br /> <br />MAP: <br /> <br /> 48R <br /> <br />TYPE= ON-SiTE SEWAG-E <br /> <br />PER~IT OR APPLICATION NO= <br /> <br />C, ONTF:AC'f Ol:;~ NO,, <br />£_OR~,~ DOUG <br />2885 SW 2';~4TH <br />I,,IILLSBORO,, OF( 97:1,2~ <br />PHONE',; 64~-7387 <br /> <br />~047212 <br /> <br />WATER SUPPLY <br />TEST HOL, ES READY: <br />SITE EVALUAT:rON NUMBER: <br />EX]',ST:[N6 TANK SIZE: <br />ExIST:IN(.;. DRAZN F'IELD LINES: <br />SEPTIC TANK F'UhPED: <br />PREVIOUS NO. BEDROOHS: <br /> <br /> I T E M Q U A N T I T Y A M 0 U N T <br /> EXISTING SYSTEM EVAL, RF'T. 1 $:I, 6~.~)~ <br /> <br /> TOTAL. AoSESSI:D FEES <br /> F'I~EVI OUS RECEIPTS <br /> THIS RECEIPT $16~. <br /> <br /> BALANI]E DIJE <br /> <br /> P, AYEE: LORE, DOUG RECEIPT ,1~: . 49~85 <br /> RECEIVED BY',', ct ........................................................................ TYPE: CK <br /> <br /> SEE ATTACRED DOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br /> * THIS IS WOT A PERMIT. TH~ APPLICATION MUST ~ THROUGH A ~E~IEW PROCESS WHERE THE <br />FOI,.,I,.OW~NG MUST BE COMPLETED. IT tS THE RESPENSIBZL'[TY OF THE AI-FI.,ICANf TO ASSURE THAT <br />ALL tlb. CEoSAEY INFORMATION HAS BEEN F'ROVZI)E~. <br /> <br />PLAN I:i:E V]i EW: <br />al.HAM',! , ESE <br /> <br />BY ............................ DATE ............ ~_. ..... CI:Ty J[R].SDICI.I. SN. BY I)ATE <br />~'F'F , ~ ~ -- ~ <br /> <br /> OFFICE COFY <br /> <br /> <br />