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· . MARION COUNTY BUILDING iNSPECTION <br /> SENATOR BLDG, NO, 225 <br /> 220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> 588-5147 8:00 - 4:30 <br /> PHON E~;O DE.A. PHON E: 588-7904 ~ // <br /> <br />t em a regLster~d builder OR ( ) the authorized reple$entative SIGNATURE 0 C <br />of a registered builder. <br />The work will be performed by a registered buif¢er. <br />Other <br />I have read and agree to the terms s~ated on the reverse side of DA'rE: <br />this documont, <br /> <br />OWNER: DA'!'E'.' 09/1,7/93; TINE: ;I,;I,~2:27 TAXLOT; <br /> CBM DEVELOPMENT 40;18--eee <br />~TgS ADDRESS~ CONSTRUCTION TYPE; <br /> <br />CATEGORY: <br /> <br /> COHM[iZRCI:AL <br />OCCUPANCY: <br /> <br /> 12094 EHlr..lr--';N RD NE COkTRACT CIT~: UGS: <br />AORORA OR 9700=, MARION COONTY N~ <br /> <br />: OCCUPANT LOAD: <br /> <br /> , NO OF BEDHOOMS <br /> <br />WlOTli; <br /> <br />:1,;,~3:~,~ EHLEI,I RD NE CONTACT S64-6&11 <br />AURORA OR 97002 .JEFF ~ALLAGEF( NUMBEi~: ~3-~3185 <br />PHONE: 678--1828 <br /> <br /> D~PTH; I AREA: UNITS; <br /> 4.52 ~C NO <br /> <br />MAP: <br /> <br /> 4 <br /> <br />TYPE: OH-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: ~049~ <br /> <br />CONTRACTOR. NO. <br />CBN I)EYELOPHENT <br />1.;;~31;~ EHLFN RD ]gE CONTACT ~&4--5 <br />AURORA OR 97~82 JEFF GALLAGER <br />PHONE: 678-!828 <br /> <br />WATER SUPPLY: <br />TEST HOLES READY: NO <br />S;rTE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EX]:S'I'ING ):)RAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />Pr(sv~ous NO, BE'.OROOHS: <br /> <br /> ITEH QUANTITY AMOONT <br />NOI..DING TANK I $255.00 <br />S',[TE EVA[.,, - r:,[I.,sl looo ~-AL 1 $26S,,O0 <br /> <br /> 'TOTAL ASSESSE~) FEES $520.08 <br /> PREVIOUS RECETPTS $2,~5,00 <br /> THIS RECEIPT $0,~ <br /> <br /> / ~~,'~',~, : <br /> <br /> / <br /> RECEIPT ,NO~, <br />PAYEE: <br /> ....... : ......... ..... ....................... <br /> <br />NOTE: 'f'-¢IS DOES NOT GRANT OF4 :[NF'LY F'EI,~MISSiON 'lr'O BUILD ON THIS PARCIEL. F'LANNtWI;; <br />ONSTRUCT;t;ON PERHITS i"lUSI' Bt.:; OCTAl;NED I.)EFORE BUI[.~,'[N6 OR SEPTIC ;lrNSTALL. A'f'ION ~.l,_,G~.No,. <br /> <br /> PLAN I",EVI[,.Wr, BY DATE [,,[TY JURISI)]iC'TION: [~Y DATF ..................... <br /> <br />REMARKS: N~:,I,.,D.I. IIG TAI,IK <br /> <br />OFFICE COPY <br /> <br /> <br />