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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 />am la.dorm ng work On a property OWh Or OCC~Dy, ~~ <br />am a r~l~tetea builder OR the [arbor{zed representative SIGNATURE O~ APPLICANT; ...................... <br />of a regi~ eted builder- <br />T~e wock will be ~dormed by a registered builder. <br />have read and agree to the te~ms stated on the revere alde of DATE: . ~ <br />I~i~ document. <br /> <br /> .... DA'(E:..05/14,/92 ..... T T~:...]5:52: 20 ............. ~4i],~v, ' ....................... ~.ATEG ORY: <br /> PiTlfERLE, ELISE K 40263000 <br />~l¥~.J~ ADDRESS: ............. ' ' Cq)S,~l'~t~g"~'lON TY~I~i ..... , OCCUP~.NC¥~ <br /> <br />CCW~ERC] <br /> <br /> 10375 CHANPOEG RD NE <br /> AURORA OR 97002 <br /> ......................... <br /> O# ~01LD,'NG: ' ........................... - ......... <br /> <br /> AU~, ,OR 9?002 ~ ~ v · ' <br /> PH~E: 6'78~1228 ~q~ ~ ~ SIl'[ N~R: 92-0T859. <br /> ~' ~ VALUAT <br /> : eL~'K ............. :'~'~+i~fil .......... 'i6~N'~fi '~ .......... ~ ~h~ ........... :' k6N~ ........... · MAP: <br /> <br /> ............. <br /> ' ,~E~J .............. ~ -~;" <br />.............. ............................... .. .... ........................... ....... <br /> <br />'TYPE: ON-SJ, I'E S~,NAGE <br /> <br />PE~?IVlIT OR APPLICATION NO: <br /> <br />~T~'r'OR, NO, <br />P[TTERLE, ELI~E K <br />10369 C~EG RD <br />~, OR 97002 <br />PH~E: 678-1228 <br /> <br />90399S7 <br /> <br /> ITEi~1 (;(JANTITY AIVIOUNF <br />SiTE ~AL, - FI R;~T 1000 GAL OGF 1 $220.00 <br /> <br /> TOTAL ASSP..'~ED F6F-~ $220.00 <br /> PRE~i~ RECEiPT~ $0.00 <br /> THIS RECEIPT $220.00 <br /> <br /> DANCE ~E $0.00 <br /> <br />PAYEEt P[TTERLE, EL[~E K R~EIPT NO: 420~0 <br />R~E~VED BY: CL TYPE: CK CHECK ~: 2179 <br /> <br />SEE ATTAC~EO ~M~]' F~R R~IR~T5 OF ~iTE S~AGE <br /> <br />NOTE: THIS OOES NOT GRANT OR iMPLY PER'~ISSION TO BUILD ~ THI~ PARCEL. PLANNING AND <br />CONSTRLJCTIC6I pERMZT~itflI.~T BE,OI~TAZNED BEFORE ~UILDiNG OR SEPTIC, INSTALLATiC~N BEG~N~. <br /> <br />OFFICE COPY <br /> <br /> <br />