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SENATOR BLDG. NO. 225 ..,~~ <br /> 220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-8147 8:00-4:30 <br /> " 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />( I am performing work of~ a property I own or occupy, <br />( I am a registered builder OR ( ) the authorized representative SIGNATURE OF APPLICANT; <br /> Of a registered budder, <br />( The work wil~ bo performed by a registored builder. <br />( Other <br />( I have read and ~(ee to the terms stated on the reverse side of DATE: <br /> this document. <br /> <br />OWN~: DA'I%: 09/07/93 TIME: IC:B![~4~ ~Ax[_bTi CATEGORY: <br /> <br /> P&CIFIC TEL. ECO~ [NC,, 4~689ff~e RESIdENTIaL <br /> <br /> 13924 EHL, EN R9 NE ~6~Cf~l~:' :OCCUPANT LOAD'. <br /> AURORA OR 97082 HARION COUNTY~ NO <br /> <br /> LARRY KR]:BS ~78-2141 <br /> SITE NUNBER: ~-8271& <br /> PHONE: 878-2141 VALUATION: <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, <br />PACIFIC TELECOM INC. <br />LARRY KRIBS 678,-2141 <br /> <br />PHONE: 678-2141 <br /> <br />49035 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: NO <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOU~ NO. BEDROOMS: <br /> <br />ITEM QUANTITY AMOUNT <br />REPAIR - MAJOR 1 $125,.00 <br /> <br /> T~TAL ASSESSED FEES $12%00 <br /> PREVIOUS RECEIPTS $125.00 <br /> THIS;RECEIPT $0.00 <br /> BALANCE DUE $0.00 <br /> <br /> PAYEE: : RECEIPT NO: <br /> RECEIVED BY. PB TYPE CHECK ~ 0 <br /> SEE ATTACHED DOCUMENT FOR REQU'IREMEN~S ::OF ON-SITE SEWAGE SYSTEM. <br /> ~ TNIS IS A VALI~ PERMIT ~ THIS pErMIT ITS ISSUE ~ATE, IF <br />CONSTRUCTION FAILS TO HEET ALL REQUIREMENTS OF STATE LAWS ANB MARION COONTY DUILDIN6 ~lqD <br />ZONING ORDINANCES~ THIS PERMIT SHALL DECOME:NULL AND ~OID, <br /> <br />REMARKS: SEFTIC REF'AIR <br /> <br />DONALD E,, WOODLEY, MARION COUNTY BUILDING OFFI¢IAt. / BY <br /> <br />OFFICE COPY <br /> <br /> <br />