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MARION COUNTY BUILDING INSPECTION <br />SENATOR SLOG, 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 />I have read and 89ree o he terms stated on the reverse side of <br />this document. <br /> <br />F'I L E- <br /> <br />S[~NATUR~ O¢ APPLICANT:~ ~ <br /> DATE~ <br /> <br /> DAI'E: 10/.1.4/93 TIME: <br />OWNER; TAX LOT; CATEGORY; <br /> STEVEN, PAUL 71580-01B RESIDENT IAI... <br /> <br />SITUS ADDRESS; CONSTRUCTION TYRE; OCCUPANCY: <br /> <br /> 1~18~ BROOKSIDE DR NE '8'ai4'r~Xa?'aiYY: ..... ...... <br /> AURORA OR 970B2 MARION COUNTY <br /> <br />,USE OF BUILDING; iN0 O~ BEOR00~S: <br /> <br /> ~YRON GRIMM ESTATES <br /> SAME <br />m PHONE: 678-1478 VALUATION: <br /> <br /> Z2~ 210 2&4&e. S~ ; NO ; NO <br /> <br />TYPE: ON-SITE SEWA6E <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR~ NO. <br />STEV£N~ PAUL <br />SAME <br /> <br />PHONE: 678-1478 <br /> <br />9858671 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: 1~00 <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPEB: <br />PREVIOUS NO. BEDROOMS: <br /> <br />288 <br /> <br /> ITEM QUANTITY AMOUNT <br /> REPAIR - MAJOR 1 $125.88 <br /> <br /> TOTAL ASSESSEDFEES $125.00 <br /> PREVIOUS RECEIPTS $8.00 <br /> THIS RECEIPT ] $125.00 <br /> <br /> BALANCEB~JE $0.00 <br /> <br /> PAYEE: STE¥?, PAUL RECEIPT NO: 53075 <br /> RECEIVE~ BY, NB .............. ~ .... .... ~ .......... TYPE: CI( CHECK ~ 297 <br /> <br /> SEE ATTACHED BOOUMENT FOR REQUIREMENTS OF ON-SITE,SEWAGE SYSTEH. <br /> <br /> ~ THIS iS NUT A PERMIT. THIS APPLICATIOMHUST GO THROUGH A REVIE~ PROCESS ~HERE THE <br />FOLLONIN~ MUST BE COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLIgANT TO ASSURE THAT <br />ALL NECESSARY INFORMATION HAS BEEN PROVIDED. <br /> <br />PLAN REVIEW: BY____.~_____ DATE_~_~_~%~ .... <br />REMARKS: RPR:HAJ <br /> <br />CITY JURISDICTION: BY .......... BATE ............................... <br /> <br /> OFFICE COPY <br />~ORM # MC 15-56 REV, 4/90 <br /> <br /> <br />