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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 />I am performing work on a property I own or occupy. <br />I am a registered builder OR ( ) the authorized representative <br />of a registered builder. <br />The work will be performed by a registered builder. <br />Other. <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br />SIGNATURE OF APPLIC <br /> <br />bw~TE: 05/29/92 TIME:~ 7:54:39 : TAx <br />Si~u~ AbDRE~§iFRAZIER~ MARY <br /> <br /> 11055 JAMES WAY <br /> Aur,15ViLLE <br />USE OF BUILDING: <br /> <br />OR 97325 <br /> <br />SE <br /> <br />MAILING ADDRESS: <br /> <br /> CATEGORY: <br /> OCCUPANCY: <br />UGB: OCCUPANT LOAD: <br /> <br /> PO BOX 713 <br /> SILVERTON OR 97381 <br /> PHONE: 479-3348 <br />LOT: BLOCK: <br /> <br />~VidYh: 8 DEPTH: <br /> <br /> SITE NUIVEIER: 92-02026 <br />RAN GEVALt~tAT-tON?z0 N ~i <br /> <br />~ AC ................ NO~ .........NO .................................... <br /> <br />TYPE: ON-si're SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />FRAZIER, MARY <br />PO BOX 713 <br />SiLVERTON OR 97381 <br />PHONE: 479-3348 <br /> <br />NA'rEREJJPPLY: ~ <br />TEST HOLES REAOY~Y,~..~_E~.~~ <br />SITE EVALUATioN NOffiSER: <br />EXiSTiNG TANK SIZE: <br />E)(ISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUffiPED: <br />PRE'VIC'X. IS NO. 8E~: <br /> <br /> QUANTITY <br /> 1 <br /> <br /> TOTAL A.SS~D FEES <br /> PRE¥iOUS RECEIPTS <br /> THIS RECEIPT <br /> <br /> BALANCE DUE <br /> <br />PAYEE: FRAZIER, MARY RECEIPT NO: <br />RECEIVED 8Y: fflB TYPE: CK CHECK ~: <br /> ........... ~== ..... =---= ............ =-= ....... <br />SEE A'F'FACHED I:X3~MEN'r FORREQUtRtEflI~dTS OF (~I--SITE SEI~N:~ sYs'rEN. <br /> <br /> AI~K1JNT <br /> $220.0O <br /> <br /> $220.00 <br /> $o,0o <br /> $220.00 <br /> <br /> $0.00 <br /> <br />42301 <br /> 200 <br /> <br />NOTE: THIS DOE~ NOT GRANT OR IIqPLY PERIVlZSSION TO BUILD ON THIS PARCEL. PLANNING AND <br />C(]NSTFIJOTION PF_I~ITS ~LLST BE OBTAINED BEFORE BUILDING OR SEPTIC INSTALLATION BS~INS. <br /> <br /> PLAN REViE'~: 8Y ............. <br /> REFIARES: SiTE EVALUATioN - -, ' ~ '72~=~ !=~:,~'~i~..;i' ' ' ~'%=' = ...... : .............. <br /> <br />OFFICE COPY <br /> <br /> <br />