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SENATOR BLDG. NO, <br /> 220 HiGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PRONE: 588-7904 <br /> <br />I 8m per o mng wok on a proper y I own or occupy. <br />I am 8, registered builder OR ( } the authorized representative <br />of a registered builder, <br />The work will be pedormed by a registered builder, <br />Other__ <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br /> :DA'fE~ ~81'L"2/93 'TIME': 1' :~8:2.', ............. <br />i OWNER~ ¥~,X LOT: CATEGORY: <br /> BISSELL,, ANNETTE I 74442-~'7:[ ~ I~ES'[~EFTIAL <br /> <br /> 61,21 SANTIAM SPRINGS CT SE ( CONYMACT CITY: UGB: OOOUPANT LOAD: <br /> <br /> AUMSVIL, LE OR 97S25 ~ MARION COUNI'~ NO ~ <br /> <br /> I SA 4T1 AM SPRINGS <br />4890 .... 71ST AVE SE <br />SALEM '~730:L ', SITE NUMBER: 9;~-026~2 <br />P HONI_:.:3&2,-3&lO , VALUATI:ON: <br /> <br /> ~ '~'z ] f~S ! 2W J ~' 5.1 ..... <br /> i 2.2: AD YES ~ NO <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION <br /> <br />60NTRACTOR,~ <br />BISSELL: AI'INETTE <br />489~" ?1ST AVE SE <br />SALEM 97301 <br />PHONE: S62'-S610 <br /> <br />48796 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: YES <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING BRAIN FIELQ LINES: <br />SEPTIC TANK PUMPED: <br />PRE¥IOUS NO. BEBROOMS: <br /> <br /> ITEM <br />S~TE EVAL, tJATION0 FIRST LOT <br /> <br />TOTAL,ASSESSES FEES <br />PRE~IOUSREOEIPTS <br />THIS, RECEiPT <br /> <br />QUANTITY AMOLINT <br /> ], $265.00 <br /> <br />$265.00 <br />$265.00 <br /> $0.00 <br /> <br />BAt. ANgE ,SUE $0,, 00 <br /> <br />PAYEE: <br />RECEIVED BY: CL ....................................................... <br /> <br /> RECEIPT NO: <br />TYPE: SNECK ~: 0 <br /> <br />SEE ATTACHED DOCUMENT FOR REQUIREMENT8 Of ON-SITE SEWAGE SYSTEM. <br /> <br />NOTE: THIS DOES NOT GRANT OR ~MF'LY PERMISSION TO BUILD ON THIS PAR&EL. PLANNING AN1) <br />ONoTRUCTION F'ERMZTS MUST BE OBTAINED BEFORE BUILDING OR SEPTIC ,1, NSTALLATION <br /> <br />REMAR <br /> <br />DOHAL. D E. <br /> <br />SE - SI'D SYSTEM NiF. E~)S S'fAKEOUT L:AYOU'f __~ <br />WBODLEY~ MAR;tON SOUNTY BliIL, I)IN60FF'~C~AL / BY _ ........................................................................ <br /> <br />ron~ ~ ~c ~.s~ ney. 4/~0 OF FICE COPY <br /> <br /> <br />