Laserfiche WebLink
MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. NO, <br /> ¢,20 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> I am performing work on a progerty I own or occupy, <br /> I am a registered builder OR the authorized representative SIGNATURE OF APPLICANT; <br /> of a registered builder, <br /> The work will be pedormed by a registered builder, <br /> Other, <br /> <br /> this document, <br /> <br /> ~.~,~ ......... <br /> <br /> 5~e N SANT~AM HWY <br /> BETROIT OR ~7342 9ETROIT I NO <br />~OB~'O~ ~OiLO~'~ ...................................................................................................................................... uo o~ ~o~oo~s: ' <br /> <br /> 4121g KINSTON LANE <br /> PNONE. 769-648~ VALUAT~OH. <br /> <br /> 5L J ~ k 8~58. ~ ~g <br />.................................................................................... ~ ................ NO ................... <br /> <br />TYPE: OH-SITE SEWAGE <br /> <br />PERHIT OR APPLICATION NO: <br /> <br />CONTRACTOR~ NO. <br />BOCHSLER~ RALPH <br />4121Q KINSTON LANE <br />STAYTON. OR 97~8~ <br />PNONE: 769~648~ <br /> <br />9048479 <br /> <br /> WATER SUPPLY: CW <br /> TEST HOLES READY: <br /> SITE EVALUATION NUMBER: <br /> EXISTING TANK SIZE: <br /> EXISTING DRAIN FIELD LINES: <br />ISEPT,IC TANK,PUMPED: <br /> PREVIOUS NO. BEDROOMS: i <br /> <br /> ITEM QUANTITY <br />AUTHORIZATION NOTICE - FLD. VISIT i <br /> <br />TOTAL ASS SSEI)'FEES <br />PREVIOUS ~ECEIPTS <br /> <br /> TYPE: <br /> INVOICE NO: <br /> <br />AMOUNT <br /> $160.88 <br /> $160.~0 <br /> $0.00 <br /> $0.00 <br /> <br /> $160.00 <br /> <br /> PAYEE: <br /> RECEIVED BY: gL CHECK f: 0 <br /> SEE ATTACHED DOCUMENT FOR,REQUIREMENTS OF ON-SITESEWAGE SYSTEM. <br /> <br /> ~ THiS IS NOT A PERHIT. THIS APPLICATION NUST Cd3 THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE COMPLETED. IT'IS THE RESPONSIBILI~TY OF THE APPLICANT TO ASSURE TNAT <br />ALI_ NECESSARY INFORMATION HAS BEEN PROVIDED. , <br /> <br /> ~,/~ , ~ ~ / <br /> <br /> <br />