Laserfiche WebLink
MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE:5884147 8:00- <br /> 24 HOUR CODE-A-PHONE: 588-7904 ..~'-~--~ '"- , <br /> <br />I am performing work on a property I own or occupy, <br />I am s registered builder OR the authorized representative SIGNATURE OF <br />of a registered builder, <br />The work win be ¢erformed by a registered builder. <br /> <br />I have reed and agree to the terms stated on the reverse side of DAT~ <br />this document. <br /> <br />BISSELL,, ANNETTE [ 74442-871 <br /> <br /> SALEM 773~1 ~ SiTE NUHBER: 93-82632 <br /> PHONE: 362--361~ ~ VALUATION: <br /> <br /> ~ ARIA; IUNITS: 8 ~ IRREG. LOT: <br /> L No i <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONIRACTOR~ NO. <br />BISSELL, ANNETTE <br />4890 - 715T AVE <br />SALEM 97~:[ <br />PHONE: <br /> <br />?~48796 <br /> <br />WATER SIJPPLY: PW <br />TEST HOLES READY: YES <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC ThNK PUMPEg: <br />PREVIOUSNO. BEDROOMS: <br /> <br /> ITEM OUANTITY AMOUNT <br /> SITE EVALUATION~ FIRST LOT 1 $265.00 <br /> <br /> $265.~0 <br /> $0.00 <br /> $265.00 <br /> <br /> $e.00 <br /> <br /> PAYEE: DENISE N. RECEIPT NO: S1119 <br /> RECEIVED BY: ~M2 TYPE: CK CHECK 8: 423~ <br /> <br /> SEE AT'rACNED DOCUMENT FOR',REQUII q-SITE, SEWAGE SYSTEM. <br /> <br /> ~ THIS IS NOT A ~ERNIT. THIS'APPLICATION NUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOgING M~ST ~E COHPLETED., IT' I:S:TWE RESPONSIBIL[TY OF THE APPLICANT TO ASSURE THaT <br />ALI, NECESSARY [NFORHATIOM HAS BEEN PROVIDED. <br /> <br />PLAN REVIEB: BY__._~__~.~ATE___~?/~.__ CI,TY ,JURISDICTION." BY ............ I)ATE ................. <br /> <br />OFFICE COPY <br /> <br /> <br />