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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 />I am performing work on a property I own or occupy, <br /> <br />SIGNATURE OF APPLfCANT: <br /> DATE <br /> <br />°wN~'I-E: 04/23/91 'rJ~ME: 14:11:04 <br /> <br />TAX LOT: <br /> <br />CON S'IRL~CTfQN ~¥PE: <br /> <br />CATEGORY: <br /> <br />R~]DEN']~Ab <br /> <br /> 120 PATRON RD <br /> oErROiT <br />US6 OF 8UILOlNG: <br /> <br />OR 9'1342 <br /> DETROIT <br /> <br />NO <br /> <br />;OCCUPANT LOAD: <br /> <br /> Nh OF BEDROOMS <br /> <br /> P.O. BOX 45~ <br /> DETROIT, OR 9?342 <br /> PHONE: 854-3441 <br />LOT: 8LOCK: <br /> <br />SECTION: TOWNSHIPi <br /> <br />SUBDIVISION; <br /> <br />SITE NUfV~ER: 9328 <br />R^N~LUAT ION: mm ~bNE: ' MAP: <br /> <br />3 <br /> <br />TYPE: ON-SITE SE1HAGE <br /> <br />PERMIT OR APPEiCATJON NO: 31661 <br /> <br />6ON'FPAc'roR, NO. 36421 <br />KEViN~S BACKHOE SERViCE <br /> BOX A65 <br />DErRO/'r, OREGON 97342 <br /> <br />NA'FER ~.JPPLY: CH <br />TE~T HOLES READY: <br />SiTE EVALUATION NUFiBER: <br />EXiSTiNG TANK SIZE: 500 <br />EXISTING DRAIN <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. <br /> <br /> II'EN <br />REPAIR <br /> <br />PAYEE: <br />RECEiVEO BY: CL <br /> <br />TOTAL AE~E~EB FE~.,~ <br />PREVIOUS RECEIPTS <br />]'HIS RE/JEt PI' <br /> <br />BALANCE I~E <br /> <br /> TYPE: <br /> <br />SEE ATTAOHEO DOCUMENT FOR RE(;~U,t:REfflE~IT$ OF ON-SiTE SEWAGE f~Y~T~4. <br /> <br /> QUANTITY AI~IOUNI' <br /> 1 <br /> <br /> ~80,00 <br /> 80.00 <br /> $o,oo <br /> SO.OD <br /> <br />iNVOiCE NO: O <br />CHECK ~: 0 <br /> <br /> ~ THIS I$ A VALID PERFiIT * TH[~ i:'EI~IZT ED(PiRES 360 DAY~ <br />C~N~TRUOTION FAIL~ TO fflEET ALL REd, JIlTS OF STATE LAh~ :AND NARiON COUNTy RUlLDING AND <br />Z~t~I/NG ORDLNANCE~. THL$ PEi~i[T ~HALL I~iEEX~E NULL AND <br /> <br />REtVLARKS: ~EP'rlC REPAIR- ¢,IAJOR ~ <br />F,;,A~ALD E. NOOOLEY, fflARION f.~TY BUILDING OFFICIAL / BY .............................................................................~_ <br /> <br />~4 ~Y MC 15.56 R~V, 4/90 OF FiCE COPY <br /> <br /> <br />