Laserfiche WebLink
MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HIGH STREET NE <br /> SALEM,, OREGON 99301 <br /> <br /> PHONE: 588-5147 8:00 - 4:SO <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performing work on a property I own or occupy. <br />lamareglsteredbullderOR( ) the authorized representative <br />of a registered builder, <br />The work will be performed by a rogistered builder, <br />Other. <br /> <br />I have read and agree to the terms stated on the reverse side <br /> <br />OWNER; ~AX LOT: ~AYEGORY: <br /> Cedars Res'l;ur'an'b & Lounge Inc. : COMMERCIAL <br /> <br /> 2~ N ~E~O~T AVE -~ !'~ ~BiY~J ~ UGh'. iOOOUPANTLOAD; <br /> DETROIT DR 97342 ~ DETRB~T : NO , <br /> <br />DAVID LAYHON <br />F'.O. .563 DETROIT~ ORE 97342 <br />PHONE: 8~4-3764 <br /> <br />SITE NUN;SER: <br />VALUATION: <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERHIT OR APPLICATION <br /> <br />CONTRACTOR. NO. ~6421 <br />KEVIH'8 BACKHOE <br />PO BOX 465 <br />DETROIT. 97342 <br />PHONE: <br /> <br />90~0606 <br /> <br />WATER SUPPLY: CW <br />TEST HOLIES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK 8IZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDRSOMS: <br /> <br /> ITEM <br />STD ONSITE SYS < 1000 GAL <br />ADDITIONAL SUBSURFACEFEES <br />ADDITIONAL. SURCHARGE ' SUBSURFACE <br /> <br />QSANTITY AMOUNT <br /> 1 $245.00 ' <br /> <br /> $10.00 <br /> <br /> TOTAL ASSESSED FEES $525.00 <br /> PREVIOUS RECEIPTS $0.00 <br /> THIS RECEIPT $525.0~ <br /> <br /> BALANCE DUE $0.00 <br /> <br /> PAYEE: I(evin N Hills INVOICE NO:: 53004 <br /> RECEIVED BY: PN TYPE: IN OHEOK ~: 0 <br /> <br /> SEE ATTACHED DOCUMENI FOR REBUtRENENTS OF SN-SITE SEWAGE SYSTEM. <br /> <br /> * THiS IS HOT A PERHZT. THIS APPLICATION HUST GO THROUGH A REVIEW PROCESS W~ERE THE <br />FOLI,.OHING NIJST ~E CO~PLETEDo IT IS TNE RESPONS~DILITY OF THE APPLICANT TO ASSURE TNAT <br />ALl. NECESSARY INFORMATION HAS BEEN PROVIBED. <br /> <br />PLAN REVIEW: <br /> <br />REMARKS: REP: <br /> <br />FORM B MC 1B.56 REV. 4/90 <br /> <br />BY.,. TE_ CITY JURISDICTION: BY ........... DATE ................. <br /> <br /> INSTALL NYDRO-SPLITTE~ CREATE NEW DISPOSAL F'(ELD CI.:',DARS RESTAURAN'f <br /> <br /> OFF~CE COPY <br /> <br /> <br />