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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. ~25 <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-i'904 <br /> <br /> J ~ffl performiF~g work on 8 property I own or Occupy. <br /> I am a registered budder OR ) the ~zuthorized representative <br /> of a registered builder. <br /> The work wilJ be performed by 8 registered bdilder. <br /> Other <br /> I have read 8nd aoree to the tetris stated on the reverse side of <br /> this dorumonL <br /> <br /> DATE: 10/07/S'3 TIME: <br />ow~: CBM DEVELOPMENT <br /> <br />SITUS ADDRS$S; <br /> <br /> 12094 EHLEM RD NE <br />AURORA OR 97002 <br /> <br />StGNATt)RE OF APPLICANT: <br /> DATE: <br /> <br /> CONSTRUe/ION TYPE: <br /> <br />USE OF BUILDING: <br /> <br />MAILING ADDRESS: <br /> <br />SUSDIV,SiON: <br /> <br />1~1~ EMLEN RD NE CONTACT <br />AURORA OR 97082 JEFF GALLAGER <br />PHONE: ~78-1020 <br /> <br />SITE <br />VALUATION: <br /> <br />BLOCK: <br />DEPTH: <br /> <br />OCCUPANCY: <br /> <br />OCCUPANT LOAD: <br /> <br />MAp: <br /> <br /> 4 <br /> <br />TYPE: <br /> <br />PERMIT OR APPLICATION <br /> <br />CONTRACTOR~ NO. <br />CBM DEVELOPMENT <br />13~t~ EHLEN RD NE CONTACT ~64-6 <br />AURORA OR 97002 gEFF 6ALLAGER <br />PHONE: 678-i~20 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: YES <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM QUANTITY AMOUNT <br />HOLDING TAMK 1 $255.00 <br />SITE EVAL.- FIRST 1000 CAE DSF 1 $~6o.00'> "- <br /> <br /> TOTAL ASSESSED FEES $520.00 <br /> PREVIOU~ RECEIPTS $52¢. <br /> THIS RECEIPT $0. <br /> <br /> BALANCE DUE <br /> <br />PAYEE: RECEIPT <br />RE6ElVE~ BY: PB TYPE: CHECK ~: <br />SEE A~TAONE~ ~OCUMENT FOR REQUIREMENTS O~ ON-SITE SEWAGE SYSTEM. <br /> <br />NOTE: THIS DOES NOT GRANT OR IMPLY PERf4ISSION TO BUILD ON THIS PARCEL. PLANNING AND <br />ONSTRUCTION PERMITS MUST BE OBTAINED BEFORE BUll. DING OR SEPTIC INSTALLA'FION GEGINS. <br /> <br />REMARI(S: SE:TH:REAdY ¢/2~/SJ/HT <br /> <br />DONALD E. WOODLEY, MARION COUNTY BUILDING OFFICIAL / BY <br /> <br />.o~, uc, ~-~..w, ¢o OFFICE COPY <br /> <br /> <br />