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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: 58S-7904 <br /> <br />SK3NAYURE OF APPliCANT; .................. <br /> <br /> DATE; ........... <br /> <br /> 04/~7,/0,4. · -TIME: -12:O6{38 ....... i't4x'L°t: ...................... :'~AY~Ebh~, ' ' <br />B1RRLqkOTT, HIgHAE[. N .. ~ ~177-1~1 iREBIDENTIAL <br /> · ........................ <br /> <br /> 14625 KASEL CT OR <br /> <br /> AURORA <br />u~ OF BU~m.~ ............................................................ ' ............................ ,i'WE: 'o~ '~b~6~s: <br /> ,. 75 <br />MAILING AOORESS: ' ............................................. -;"{~5~6i~F~i'5~; ........................................ <br /> ':. [( &S~I,.....~P UJ~T __P.H~ ~12 .................... <br /> ,1'755 N MAPLE <br /> CANBY~ [IR 970],3 SITE NUIIBER: 94~481~9 <br /> F'I,~ONE: 26~-835S VALUATION: <br /> <br />PERMIT OR APPLICATION NO-' ?854852 <br />6UNI',,E,'ACTQR~ NO. 44~77 <br />Hem'y Allui$ E×cava+tng Li'd I <br />400 [.oar Rd ' <br /> <br />I:,~J0NE~ 87~-4~47 ~ <br /> <br /> WATER SUPPLY: 6W <br /> TEST HOLES READY: <br /> SITE EVALUATION NUMBER: <br /> KXI8TING TANK <br /> i EXISTING DRAIN FIELD L~NE~: <br />., SEPTIC TANK PUMPED: <br /> PREVIOUS NO. BE~ROOMS~ <br /> <br /> ITEM OUANTITY AMOUNT <br />Sl'ANQARD ON-SITE SYSTEM i $~,.~,~.~0 <br /> <br />TOTAL ASSESSED FEES $255,,~0 <br />,: , PREVIOUS RECEIPTS· $0.00 <br />'' THIS RECEIPT $255.00 <br /> <br /> BALANCE DUE $0.08 <br /> <br /> PAYEE; Hm~y Alluis Excavati,m i Ltd ..... ': INVOICE NO: 56317 <br /> RE'CEIVED BY: PM ............. ~__~ ............. ~ .... TYPE~ IN CHECK ~: ~ <br /> SEE ATTACHEQ DOCUMENT FOR REQUIREMENTS: OF ON=SI!E SEWA'EE .SYSTEM. <br /> <br />FOL.O~].N~ ~UST ~[ CSHPLE3~D.' ~T~'[~ THE' RESPONSibILITY OF THE ~PPLZC~NT TO ~SSU~E THaT <br />AI,L IH:,,[ [~ARY INFORMATION HAS BEEN PROVIDED. <br /> <br />PLAN REV:fEW: BY DATE <br />REHARKS: SS <br /> <br />CITY JURISDICTION: BY DATE <br /> <br />OFFICE COPY <br /> <br /> <br />