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SALf <br /> <br /> BUILDING INSPECTION <br /> BLDG. NO. 225 <br />IGH STREET NE <br /> OREGON 97301 <br /> <br /> PHONE~ 588-5147 8:00 - 4:80 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> The work will be performed by a registered builder, <br /> Other <br /> <br /> DATE: 0~/~0/~ TINE: <br /> <br />SITUS ADDRESS: CONSTRUCTION TY~E; <br /> <br /> 7?08 STONE FIELD CT SE <br /> AUHSVILLE OR 97;~25 ~NCi~IJhlI'Y: u~8 <br /> <br />c'~E~ENT I AL, <br /> <br />OCDUPAND¥: <br /> <br /> STONE FIELD GLEN <br />777,1. TERRANCE LAIIE <br />AUM;~VI,...LE.I' 1 ': 97825 WK '~-7~¢0.-4,~.,2~-~ [liTE' 'NU~[iEI~:' 9;];~1!13:~92 <br />PNONE: 74~?-"2666 VALUATION: <br /> <br />!L6f: <br /> 4 <br /> <br />WIDTH; <br /> <br />BLOCK: : ' .......... <br /> : SECTION; ; TOWNSHIP: I RANGE; ~ ZONE: MAD: <br /> 26 88 2W AR 51 <br />DE¢YH: AREA: 5. i UNIT~C , In~O, LOT: <br /> <br />TYPE: OH-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION HO: 9858354 <br /> <br />CONTRACTOR., DO,, 44551 <br /> Dwatn Betfiel & Sons Excavation <br />PO Box 5~4 <br />Turner, OR <br />PHONE: <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTIN{~ TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPEB: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> SAFilO FILTER i $455.00 <br /> <br /> TOTAl_ ASSESSED FEES '"'= <br /> PREVIOUS RECEIP'r8 $0.08 <br /> THIS RECEIPT $455,8~ <br /> <br /> BALANCE DUE $0,, e~ <br /> PAYEE: MAr<C NEtLSON RECEIPT NO: ~742 <br /> RECEIVED BY: Ct ....................................................... :;==_L2 TYPE: CK CNECK ~: 1525 <br /> <br /> SEE ATTACHED DOCUMENT FO~ REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br /> * THiS IS NOT A PERMIT.' THIS APPLICATION MUST ~0 THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING ~UST BE COMPLETED. IT IS THE RESPONSIBI,~.];TY OF TNE A~ FL .... ~(.~,/' TO Ac,'~ _~...""':' Tl, i;T'~- <br />ALL NECESSARY INFORMATION HAS BEEN PROVIDED. <br /> <br /> OFFICE COPY <br />FORM # MD 15-56 REV, 4/9o <br /> <br /> <br />