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SENATOR BLDG, 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: 888-7904 <br /> <br />of a registered buirder, <br />The work will be performed 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'[[,'_'." 09/17/9:3 T_THE: i2:~3:~3 <br /> ROBEI_L_O~ ROBERT & GAIL, <br />SITUS ADORESS; <br /> <br />TAX LOT: CATEGORY; <br /> 75;:~00-930 RES I DENT I AL, <br /> <br /> 8754 SHAW SQUARE RD SE :"bURTR'A~TdI~; LI~81 iOCCU~ANT LOAO: <br />AUMSVILI,,,E O~ 9732~ MARION COUNTY~ NO ~ <br /> <br /> SITE NUMBER: ?3-02771 <br /> F'HONE: 364-1655 YALUATION: <br /> <br /> ~ 1~ .............. 8S .... 2W AR <br />iW DTH; DEPTH: i AR~A; ! UNITS; IRREG. LOT: ; CORNE~; <br />~ i99 ,! I~58! 210542.! SF i NO , NO <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION <br /> <br />CONTRAC'fOR~ NO., 43182 <br />gami, el Moret'b <br />~243 Sunnyview Rd NE <br />Sale~,G 97385-0000 <br />PHONE: 585-6903 <br /> <br />47~98 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NOHBER: <br />EXISTING TANK SIZE: 1000 <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: ~-1-93 <br />PREVIOUS NO. BEDROOMS: 3 <br /> <br />240 <br /> <br /> ITEM QUANTITY AMOUHT <br />AUTHORTZATION NOTICE '- FLD,, VISIT i $180.00 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$160,00 <br />$160.00 <br /> $0.00 <br /> <br />BALAHCE DUE $0.00 <br /> <br /> PAYEE: RECEIPT NO: <br /> RECEIYE~ BY~ F'B TYF'E: CHECK ~: 0 <br /> SEE ATTACHEP DOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM, <br /> ; THIS IS A VALID PERMIT ~ THIS PEfl~tIT EXPIRES 368 DAYS FROM ~TS ISSUE DATE. IF <br />CONSTRUCTION FAILS TO NEET ALL REQUIREMENTS OF STATE LAWS AND MARION COUNTY BUILDING AND <br />ZONING ORDII,IANCES~ THIS PERMIT SHALl_ BiESOME NOLL AND <br /> <br />REMARKS: HDSHF,~ MS <br /> <br />DOI,IALI) ii'_',, WOODLI_::Y, MARION COUNTY BOILDIIq[;- OFFICIAL / BY <br /> <br /> OFFICE COPY <br />FOFtM # MC t 5-56 REV, 4/'30 <br /> <br /> <br />