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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 /> BATE:: r, <br /> ~9/23;/95 TIME. 1 ;I,. 47.4~; .... <br />OWNER: . TAX LOT: <br /> <br /> MAEVERNICK.~ KEN B 57279-001 <br />S~TUS ADORESS~ <br /> <br /> RES IDENT ]:AL <br />OCCUPANCY'. <br /> <br /> UGB: <br /> 7877 LIPSCOMB ST SE : CONTRACT CITY: !0~CLJ~,ANT LOAD: <br />AU~ISVIL. LE OR 97325 ~ MARION COUNTYi NO <br /> <br />SANE: <br /> <br />PHONE: <br /> <br />SITE NUMBER: <br />VALUATION: <br /> <br />,Lof: ?LOCK; i'~i'~'Ni ............. ~ fdi'~ii~i ..... PAN'El I' ~0~: ...... MAP: <br /> <br />:WIDTH: [DEPTH: : AREA; UNITS; · , : <br /> ~ 2 3: AC : NO NO <br /> <br />TYPE= ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATIUN NO: <br /> <br />COil fRAC fOR, NS. <br />HAI~.VERNICK, KEN B <br />SANE .-' <br />PHOIq ;.~' <br /> <br />I WATER SUPPLY: PW <br /> TEST HOLES READY: <br /> S:[TE EVALUATION NUMBER: <br /> EXISTING TANK SIZE: <br /> EXISTING DRAIN FIELD LINES: <br /> SEPTIC TANK PUMPED: <br /> PREVIOiJS NO. BEDROOMS: <br /> <br /> ~TEN QUANTITY AMOUNT <br />STANBARB ON--SITE SYSTEM 1 $~.5.~.00 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$25%00 <br /> $0.00 <br /> <br />BALANCE DUE $0,00 <br /> <br />PAYEE: RECEIPT <br /> <br /> RECEIVED BY: PB ....................................... TYF'E: CHECK 8: 0 <br /> SEE ATTACHED DOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br /> * THIS IS A VALID PERHIT ~ THIS PERMIT EXPIRES ~&80AYS FROM ITS ISSUE ~ATE. IF <br />CONSTRUCTION FAILS TO NEET ALL REBUIEENENTS OF STATE LAWS AND MARION COUNTY BUI DInG AN~) <br />ZONING ORDINANC, ES~ THIS PERMIT SHALL BECOME NULL, AND VOID. <br /> <br />REMARKS: STD SYSTEM <br /> <br /> ,.tJ]l...D.,.I.(., OFFICIAL / BY <br />I)OhlAi_.l) E':.. bIOODI_.iEY,~ MARTON COL.iNTY ~ ' ~'~- <br /> <br />OFFICE COPY <br /> <br /> <br />