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MARION COUNTY BUILDING INSPECTION <br />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: 588-7904 <br /> <br />f am performing work or/a property I Own or occupy. <br />lamaregisteredbuilderOR( ) the authorized representative <br />ol a registered builder, <br />The work will be performed by a registered builder. <br />Other. <br /> <br />I hsvO read arld agree to the terms stated on the reverse side of <br />this document. <br /> <br />SIGNATURE OF APPLICANT; <br /> DATE; <br /> <br />OWN~)C~'rE: 01/07/92 <br /> COAKLEY. <br /> <br /> TIME:' t1:01:47 <br />qODNE¥ & rqARiA <br /> <br /> 5'185 '..~AW HNY <br /> AUIv~VILLE <br />USE DP 8UILOING: <br /> <br />OR 97325 <br /> <br />SE <br /> <br /> CONTRACT ~lT1 <br /> <br />MARION COUNTY <br /> <br />SUSDIVISION; <br /> <br />56055-000 <br /> <br /> UGB <br /> <br />CATEGORY <br /> <br />OCCUPANCY. <br /> <br />OCCUPANT LOAD <br /> <br /> PHONE: <br /> <br />LOT: <br /> <br />WIDTH: <br /> <br />581-18'12 <br /> <br /> BLOCK: <br /> <br />DEPTH <br /> <br />SECTION TOWNSHIF <br />AREA 1,~ UNITS 8S <br /> 4.._.9 ............. AC <br /> <br /> SiTE NUMBER: 97-00214 <br /> VALUAT I Cf4 .* <br />RANGE ZONE <br /> <br />RREG LOT' l[f~ CORNER AR <br /> <br />NO NO <br /> <br />RES], DEN I iAL <br /> <br />MAP¸ <br /> <br />TYPE: ON=SiTE SEWAGE <br /> <br />PERMIT OR APPLiCA'rioN NO: <br /> <br />CONTRACTOR, NO. <br />COAKLE~¢, ROONE¥ & I~ARIA <br />S~4'4E <br /> <br />PHONE+* 581-1872 <br /> <br />37670 <br /> <br />fNATER ~SUPPLY: P~ <br />TEST HOLES READY: <br />SiTE EVALUATiON NUfCSER: <br />EX!IS'riNG 'r~K SIZE: <br />~ISTING DRAIN FIELD LINES; <br />~EP'FIC T~K ~MPED: 4-11~88 <br />PREVIa8 NO. BED~t <br /> <br /> i I'Ef4 QUANT i TY A~IOUN T <br /> ANNUAL E-¥AL. - 'rEMp OR HOf:~P ~ 1 $50.00 <br /> <br /> TOTAL ~ED FEES $60.00 <br /> PRE¥I OUS RECEi p'rs $0+00 <br /> THiS RECEIPT $60.00 <br /> <br /> BALANCE 0UN $0. O0 <br /> PAYEE: PLANNING DEP'r 'rRANSFERE RECEIPT <br /> RECEI'VED BY: CL TYPE: CK CHECK ~: 0 <br /> SEE ATTACHED 00OJ,~,lB'4'r EOR REQUIRE~IEN'rs OF ON-si'rE SE'~ACE <br /> <br /> * TH[8 18 A VALID PE~4IT m THIS PERC~IfT EXPIRE~ 360 OAY~ <br />CONSTRUCTION FAILS TO I~IEET ALL RIB~UIRIB~ENTS OF STATE ~ AND f4ARION COUNTY RUJLDZN6 AND <br />ZONING ORB.[NANCE~, THI~$ PEI;~'T ~r,IALL IBEC~E NULL AND VOID. <br /> <br />REA4,AR~: H.CY. SP RIE'4E~'~AL (PLANNING WiLL CREDIT OEP'r) <br />[~¢~ALD E. ~¢DODLE'Y, fvt&R.[ON COUNTY BUILB.[NG O~'FICIAL / BY ....................... ~ .................................................... <br /> <br />OFFICE COPY <br /> <br /> <br />