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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97'301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: S88-7904 <br /> <br />I am performing work on a property I own or OCCUpy. <br /> <br />OWNER; <br /> DATE: 05/2~/9:~ TI~EI: :L1.:;44:00 <br /> <br />:S,TUS ACI~.q~;;, DOUG <br /> <br /> 11704 DITTEP, DR <br />USE dE eu md ¢~JMSVILL E OR <br /> <br />TAX LOT'. <br /> <br />CONSTRUCTION TYPEz <br /> <br />CONTRACT CITYz UGB: <br /> <br /> CATEGORY; <br /> <br />, OCduPANT LOAO: <br /> <br /> ~o <br /> <br />LOT: <br /> <br />2885 SW '~'~ <br /> ~,,,;,4TH <br />I-iLLSBORO,. OR 9'?123 <br />F H Ol'IE~;Lo~t<4 ¢ -73(~7 <br /> SECTION: <br /> <br /> SiTE NUMBER: ?3-01748 <br />'IOWNSHIP; V~T!ON: io~: MAP: <br /> <br />DEPTH; AREA: UNITS; IRREG LOT: coRNER; <br /> 28 80 1W AR <br /> <br />48R <br /> <br />TYPE: ON-SITE SEWAEE WATER SUF'f-"LY <br /> TEST HOLES I~EADY: <br />PERi, IT OR APPLICATI'ON NO: ~47212 SITE EVALUATION NUMBER: <br /> EXISTING TANK SIZE: <br />COI,I'fRAC'TOI~ NO,, . I ~ EXISTING DRAIN FIELD LINES: <br />LORI~ DOUG ~ ~¢ ~[ ) SEF'T2C '~ANK PUMPED:1 <br />288~ SW 224TH O~.~v~i~ PREVIOUS NO,, BEDROOMS: <br />HILLSBORO,, OR 97123 ~_~ .~ ,~ <br /> ............. ......................................................................... <br /> <br /> ITEM QUAN'fiTY AM8UNT <br />EXISTING ,~YSTEM EVAI.... RP]'. 1 $:1.60.00 <br /> <br />TOTAL ASSESSED FEES <br />F'REV IOU,S RECEIPTS <br />THIS RECEIP'T <br /> <br />BALANCE DUE ~:1.60,, 00 <br /> <br />PAYEE: RECEIPT I,lO: <br /> <br /> RECEIVED BY:: cI TYPE: CHECK ~: 0 <br /> <br /> SE.E ATTACHED DOCSMENT FOR REQUIREMENTS OF ONe-SITE SEWAGE SYSTEM. <br /> <br /> ~ THIS IS NOT A PERMIT. THIS APPLICATION MUST ~ THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE. COMF'LE'I'ED, IT IS THE RESPOI~S]:BILITY OF THE APPLICANT "['0 ASSURE ]'HAT <br />ALL, NECESSARY INPORHATION HAS BEEH PROVIDE~. <br /> <br />F'I,,,AN REVIEW;; BY ................................... DATE ..............................CITY JURISDICTION: 'BY .......................... <br /> <br />Rr.,HAkkS, ESIE HOLD.~ F'F , ~I, BDRMS & CERT SI6N (BAL DUE) <br /> <br />DATE .................................. <br /> <br />OFFICE COPY <br /> <br /> <br />