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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 />Iarn performin9 work on a property I own or occuSy, ~'~)~ . ( I ~ <br />[ am ~ registered builder OR ( ) the a~thorized representative SIGNATURE OF APPLICANT~ ~-~ <br /> <br />: CARL & ' ~ ' <br /> ,RUBY, HOEHANI4 : t,-..[(ES.'r,DENTZAL <br /> <br /> ~242 SANTIAFL LOOP SE , CONTRACT CITY: I UGB: IOOCUPANT LOAD: i <br /> MARION COUNTY NO <br /> <br />PHONE: 769-6757 <br /> <br />SITE NUHBER: 93-~2976 <br />VALUATION: <br /> <br />TYPE= ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION HO: <br /> <br />60NTRACTOR~ biO. <br />CARL, & RUBY HOFFlANN <br /> <br />9~49482 <br /> <br />FHONE. 769-6757 <br /> <br />WATER SUPPLY <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING BRAIN FIELB I. INES~ <br />SEPTIC TANK PUMPEQ: FEN GVN <br />PREVIOOS NO. BEQEO0~S: ~ <br /> <br /> ITEM QUANTITY AHOUNT <br /> AUTHORIZATION NOTICE - FLU. VISIT 1 $160.80 <br /> <br /> TOTAL ASSESSED FEES $160.00 <br /> PREVIOUS:RECEIPTS $8.00 <br /> THIS RECEIPT $t60.00 <br /> ~'%t B~LASOE'DUE' $0.O8 <br /> PAYEE: BARI_ & RUBY HOFNANN x~J~--~' ' r : : RECEIPT NO: , 51846 <br /> RECEIVEB BY: PM ___~___ TYPE: CK CHECK ~: 2954 <br /> <br /> SEE ATTACHED BOCUMENT FOR REQUIREMENTS,OF QN-$ITEBEWAGE SYSTEM. <br /> * THZS IS NOT A PERMIT. THIS APPLICATION HUST ~1 THRIAJGH A REVIEW PROCESS ~HERE THE <br />FOLLOWING MUST BE COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORMATION HAS BEEN PROVIDEB. <br /> <br />REMARK8.~ <br /> <br />BY ............DATE <br /> <br />FORM # MC 15-56 REV. 4/90 OFFICE COPY <br /> <br /> <br />