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MARION COUNTY BUILDING INSPECTION <br />SENATOR BL,~G. NO; 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 973,01 <br /> <br /> PHONE: $88-$147 8:00 - 4:30 <br /> . 24 HOUR COD~-A'PHONE: 588'7904 .~"~ [,~ <br />I am a registered builder OR ( ) Ihe autho¢ized representative ~IGNATURE OF <br /> <br /> DATE: ~.0/28/92 TIME: .L[:57:32 <br /> <br />FAGAN, ~ICHARD <br /> <br />DATE: ......... ~ ................... <br /> <br />· CATEGORY', <br />: RESIDENTIAL <br /> <br />LOT: <br /> <br />W~DTH: <br /> <br /> SITE NUHBER: 9~-05029 <br /> PHONE: 749-284l ; VALUATION: <br /> <br />........ ~L~ ......... S~I'dN: ...... ~ ~WNSHI~" ..... ~ RANGE: <br /> <br />TYPE= ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION MO: <br /> <br />CONTRACTOR, NO. <br />FAGAN, RICHARD <br /> <br />PHONE: 749-2841 <br /> <br />904~489 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE; <br />EXISTING ORAIN FIELO LINES: <br />SEPTIC TANK PUMPEO: 8AVE <br />PREVIOUS NO, 8EDROOM$: <br /> <br /> IT~M QUANTITY AMOUNT <br /> AUTHORIZATION NOTICE - FLO. VISIT 1 $130_00 <br /> <br /> TOTAL ASSESSEO FEES $130~00 <br /> PREVIOUS RECEIPTS $0.00 <br /> THIS RECEIPT'. $i~0.00 <br /> · BALANCE DUE $0.00 <br /> PAYEE: FASAN, RICHARD RECEIPT NO: 45580 <br /> RECEIVED BY: CE ...... " ' TYPE: CK CHECK ~: 172~ <br /> SEE ATTACHED OOCUMENT FOR ~EQUIREHENTS. OF'ON-SITE'SEWAGE.SYSTEM. <br />~ THiS IS NOT A PEEHIT. THIS APPEICATION ~US~ 80 THROUGH A REVIE# PROOE$S WHERE THE <br />FOLLOWIN~ MUST 88 COMPLETED. IT IS THE ~ESPON3ISILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORMATION HAS SEEN <br /> <br />PLAN <br /> REVIEW: <br />REMARKS: AUTH .,~ / ~/ /. ' ~.~ ~ . "-,,~. ~ ..... <br /> <br /> <br />