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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />2:20 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 a registered builder Ok ( } the aulhorlzed represent:afire <br /> <br />OATE: 06/24/9~ TI'NE.* ~-+ 3~.-* 28 <br /> <br />SIGNATURE OF APPUCANT: <br /> <br />DATE; ............... <br /> <br /> OWNER; .............. '~A~ '~,o'r: ................... ' CATEGORY; <br /> E.I'4ERY, ADRIAN C. JR. & JANET IE. 90250-020 <br /> SITUS ADr~E~;= .............................. C~)'N~TR'Ub¥16N' ~V~I~', ...................... <br /> OCCUPANCY: <br /> <br />130 LAKECRES'r OR ' ., <br />DETROIT OR 97342 :-~6~¥~'~fC-,T-¥:' ...... U-G~.:'" 'OCC[~PANT LOAD; <br /> :, DETROi T NO <br />USE o¢ ~UILOING: ....................................................................... <br /> <br />PO BOX <br />AU~ViLLE OR 97325 <br />PHONE; 749-2624 <br /> <br />PATTON ADD <br /> <br /> E, ITE NUNBER: 92-01760 <br /> VALUA T i ON: <br /> <br /> 01 30 5E , ~ <br />16376. UNITS; ~F ' tRREG, LOT; NO ?~RNE~0' <br /> <br /> TYPE: ON-SITE ~E1NAGE <br /> PERNIT OR APPLICATION NO: 39841 <br /> <br />CONTF~t. CTOR, NO. <br />E~vI[RY, ADRIAN C. JR. ~ JANET E. <br />PO BOX 439 <br />AU~VILLE OR 9?325 <br />PHONE: 749-2624 <br /> <br />HATER ,i~IJpPLY: CW <br />T~r.,.~T HOLF..~ READY; <br />5iTE ~,~ALUATION NUMBER: <br />EXISTING TANK 5[ZE: 1000 <br />E:,~[~TJNEi BRAIN P',[ELO LINES.+ <br />SEPTIC TANK PUMPED: 08/09/,91 <br />PREVIOUS.NO. BEDROOD~: <br /> <br />RES i D~N' <br /> <br /> ITEM <br />AUTHORIZATioN NOTICE - ;~LO. VISIT <br /> <br />QUANTITY <br /> 1 <br /> <br />AMOUNT <br /> $130.00 <br /> <br /> ~130.00 <br /> 130,00 <br /> $0,00 <br /> <br /> TOTAL A,.%SE~ED FEES <br /> PREVIOUS RECEIP?S <br /> THiS RECEIPT <br /> <br /> BALANCE 0UE $0.00 <br /> PAYE~ INVOICE NO: <br /> RECEIVED BY: PI~ 'rYPE: CHECK ~: O <br /> SEE ATTAC~Eo L3OCUN~T FOR REQUIRE.~ENT~ OF ON-SiTE SE~GE SYSTEN. <br /> <br />* THiS 1~ A VALID PE~[T ~ THIS PEI~,IIT EX, PIRE~360 DAY~ PI~ IT~ IS.SUE DATE. IF <br />C~NSTRUOTION FAILS TO MEET ALL RE~UIR~NT~OFSTATE LA~ AND MARION COUNTy BUILDING AND <br />Z~iNG ORdiNANCES. THIS PE~IT E~HALL 8E'~ENULLANDVOID~ <br /> <br />RENARKS: AUTH SEE REVISED PLOT PLAN DA'rED 6-12-92 <br /> <br />DONALD E, ~¢,}OOLEY. r,!ARION COUNTY BUILDING OFFICIAL / BY <br /> <br />~O,M ~ ~C ~S.~ ,~V. <~ OFFtCE COPY <br /> <br /> <br />