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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br />OWNER: DA'fE~ 09/15/93 T'rHE: '~,~); ~:6~ 1,,~,. TAX LOT. <br /> C~M DEVELOPMENT 4e:~ls-.,eee <br /> <br /> 12e94 EFILE~ RD NE <br /> AORORA OR 978~2 NAR;iON COUNTY ~0 <br />USE OF BU~LBfN~' <br /> <br />MA~LINC ADDRESS: <br /> <br /> PHONE: 588-5147 8:00- 4:30 . ~ <br /> <br />I am a registered builder OR ( ) the authorized represuntative SIGNA'IURE OF APPLICA <br />of a registered builder. <br />The work will be performed by a registered buitder. <br />Other <br /> <br />;1.331.~ EHLEN RD NE CONTAOT ;364-6611 <br />AUROI:~A OR 970Q2 JEFF GALI.,.AGER <br />PHONE: 678-1020 <br /> <br />TOWNSHIP. <br /> <br />......... <br /> <br />4,52 AC <br /> <br />LOT' BLOCK SECTION <br />WIDTH' DEPTH. ARE~. <br /> <br />SUBDIVISION <br /> / <br /> SITE N~ER: <br /> VAI.,.UA/~F~ON: <br /> <br /> NO <br /> <br />OCCUPANT LOAD <br /> <br />93-83185 <br /> <br />COR~ 4 <br />NO <br /> <br />TYPE: 0H-SZTE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: 98499Z6 <br /> <br />COl l]RACfOR,I NJ),, <br />[;BM 5EVEi,.,OPNEN'f <br />:1.21,i:1.3 EHLEN RD NE CONFA,.,f <br />AtJROI~A OR ~7882 JEFF GALLAI;ER <br />PHONE:: 47S'"'1 e28 <br /> <br /> SUF'F*LY: PW <br /> HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXi[STINg. TANK SIZE: <br />EXISTING DF(AtN FIEI,,,D LINES: <br />SEPTIS TANK pUHPEI): <br />PREVIOUS NO, BEI)RO0~S: <br /> <br /> :1: "[' E H <br />H3L. DING TAI4K <br /> <br />QUANT I TY AN(]UNT <br /> 1 $ 25':] ,, 00 <br /> <br />TOTAL ASSESSEQ FEES <br />PREVIOUS RECEI!:'TS <br />THIS RECE:[PT <br /> <br /> $0,00 <br />$255,00 <br /> <br />BALANCE DUE $~,00 <br /> <br />F'AYEEI', STANDARD C(]I,IT INS <br />P, ECEIYED BY: HB <br /> <br />RECE I P'f' NO: ,J ,. &.:',=. <br />TYPE.' CK CHI=,CK <br /> <br />SEE ATTACNED DOCUM[ r I--OR RE[iOIRENENTS OF ON=S).?E SEWAGE SYS'fEM. <br /> <br /> * THIS IS NOT A <br />F'OLLOWINI; HtJST BE: <br />ALL. NECESf:;ARY INF <br /> <br /> THiS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE THE <br /> TT IS THE RESPONSIBILITY OF THE APF'L]X;AN'I TO ASSOI.,= THA'T' <br />~HAT]',0N HAS BEEIq F'ROVI]0ED. <br /> <br />F'LAN I.I..\.J W,, BY DATE ............................ CITY JURIS~]ICT]ZON: BY .............................. DATE <br /> <br />REHARKS: HOLDING TANK <br /> <br />OFFICE COPY <br /> <br /> <br />