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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 />I have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br />SIGNATURE 'OF APPI.:ICANT: <br /> <br />DATE: <br /> <br />DATE: 07/06/92 TIME: 9:25:21 <br /> <br />FRAZIER, HARY <br /> <br /> 1[055 ,]'AMES WAY SE <br /> AUMSVILLE 0R 97525 ~(:~UNTY u~ <br /> <br />i USE OF BUILDING: [NO. OF BEDROOMS: <br />~FMAILING ADDRESS: I~6~D-~i~-~F- .............................................. <br /> <br /> PO BOX 713 <br /> SILVERTON OR 97381 <br /> PHONE: 479-3348 <br /> <br />' !LOT: I <br /> <br /> SITE NUHBER: 92-02026 <br /> VALUATION: <br /> <br />TSECTION: '[TOWNSHIP: I RANGE: TZONE: <br />i 29 i 8s I zw AR <br /> <br />IMAP: <br /> <br /> 48 <br /> <br />TYPE: ON-SITE SEWAGE ' <br /> I <br /> <br />PERMIT OR APPLICATZON NO: 40263 <br /> <br />CONTRACTOR, NO. <br />FRAZIER, MARY <br />PO BOX 713 <br />SILVERTON OR 97581 <br />PHONE: 479-$348 <br /> <br /> ITEH <br />SITE EVALUATION, <br /> <br />PAYEE: <br />RECEIVED BY: PB <br /> <br />SEE ATTACHED DOCUMENT <br /> <br /> WATER SUPPLY: <br /> TEST HOLES READY: YES <br />JSITE EVALUATION NUMBER: <br /> EXISTING TANK SIZE: <br />I EXISTING DRAIN FIELD LINES: <br />I SEPTIC TANK PUMPED: <br />J PREVIGUS ~0. BEDROOMS: <br />I <br />I <br />I <br /> <br />QUANTITY AMOUNT <br /> 1 $220.00 <br /> <br /> ' "'. ~,!: ,' :TOT~:':.~_~..'.~:' FEES <br />.'.".. ,~..' 7 ii';":::"...."~.' ""' "=TH I S REOE'~'PT <br /> <br />:. ,~ ,...= BALANCE DUE <br /> <br /> RECEIPT NO: <br />TYPE: CHECK #: 0 <br /> <br />$220.00 <br />$220.00 <br /> $o.oo <br /> <br />$0.00 <br /> <br />NOTE: THIS DOES NOT <br />ONSTRUCTION PERMITS <br /> <br />G~AN~i':!,~:,:'"'i:~'Iit~,r:'~Z~J~'O~'m:To::~I,~,I:~O' N THIS PARCEL PLANNING AND <br />HUST. BE OBTAINED BEFORE. BUILDING OR SEPTIC INSTALLATION BEGINS. <br /> <br />REHARKS: <br /> SITE <br /> EVALUATIQN ~.. *DEHJED* <br />DONALD E. WOODLEY, MARtOH" COUNTY BUiLOIN~OFFIi <br /> <br />OFFICECOPY <br /> <br />FORM # MC 15-56 REV. 4/90 <br /> <br /> <br />