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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STREET NE <br />,SALEM, O~EGON, 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 property [ own or Ocoupy <br />I acs a registered builder OR ( ) the authorized representative <br />of a registered builder, <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 /> DATE: 08/20/92 TIME: i~:52:04 <br /> <br />OWNER; COX-~)UINTON, PM[I,,;~'P ~ DEBRA <br /> <br />SIGNATURE OF APPLICANT; <br /> <br /> 165 CLIFFORD AVE <br />DETROIT OR 97342 <br /> <br />~ONSTRUCTION TYPE: <br /> <br /> DE:rROI'I' <br />CONTRAGT CITY~ <br /> <br /> UCCOPANCYI <br /> <br />:oCCUPANT LOAD; <br /> <br />USE OF BUH. DING] <br /> <br />MAIL. lNG ADDRESS: <br /> 3746 SW COMUS <br /> PORTLANO OR 97219 <br /> PHONE: 245"%438 <br /> <br />sUao~v,sEf~TTON TI <br /> <br /> VALUATION: <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />COX--GUINTON, PHILIP & DEBRA <br />3746 SI4 COMUS <br />PORTLAND~ OR 97219 <br />PMONE: 245-'6438 <br /> <br /> TEST MOLES READY: YES <br />9042049 SITE EVALUATION NUMBER: <br /> I EXISTING TANK SIZE: <br /> EXISTING DRAIN FIELD LINES: <br /> SEPTIC TANK PUMPED: ~ <br /> PREVIOUS NO. BEDROOMS: <br /> <br /> ITEH <br />SITE EVALUATION, FIRST LOT <br /> <br />PAYEE: COX-~UINTON, PHILIP & DEBRA <br />REOEIVEO BY: <br /> <br />TOTAL ASSESSED FEES <br />PREVI09S RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY AMOUN'T' <br /> 1 $220.G0 <br /> <br />$220 ,. <br /> $0 ,, O0 <br />$220. O0 <br /> <br />8ALANCE DUE $0.00 <br /> <br />INVOICE NO: 44092 <br />TYPE~ IN CRECK ~: 0 <br /> <br />SEE ATTACGED DOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br />NO'rE: THIS GOES NOT GRANT OR IMPLY PERMISSION TO BUILD ON TItlS PARCEL. PLANNING <br />ONSTRUCTION PERMITS MUST BE OBTAINED BEFORE BUILDING OR SEPTIC INSTALLATION BEGINS. <br /> B Y__~ATE__.~,y.'fjEz'~/~'~.--¢aI TY JURI SD ICTI ON: BY ....................... DATE <br />PLAN <br /> REVIEW: <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 REV. 4/90 <br /> <br /> <br />