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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 />( <br />( <br />( ) <br />( ) <br />( ) <br /> <br /> am performing work on a Property I ownor occupy. <br />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 APPLICANT: ........................................... <br /> DATE: <br /> <br />I 11B55 JAMES WAY SE <br />I AUMSVILLE OR ?7325 <br />l~L OF BUILDING: <br /> i~G AD~: <br /> <br />TAX LOT: <br /> <br />CONSTRUCTION TYPE: <br /> <br />CONTRACT CITY: T UGB: <br />HARION COUNTY <br /> <br />CATEGORY: <br /> <br />P,E_~NTJAL_ <br />OCCUPANCY: <br /> <br />OCCUPANT LOAD: <br /> <br />'~' OF BEDROOMS: <br /> <br />11045 JAMES WAY <br />AUMSVILLE OR 97325 <br />PHONE: 749-3348 <br /> <br />SUBDIVISION: <br /> <br />SITE NUNliER: 94-B1766 <br />VALUATION: <br /> <br /> RANGE: T ZONE: <br /> i~'~G, LOT: { <br />NO _ LNo <br /> <br />MAP: <br /> <br />PERNIT OR APPLICATION NO: <br /> <br />CONTRACTOR, N0. <br />FRAZIER. HARY <br />11045 J~MES WAY ...;: <br />AUHSVILLE OR 97325 ~ <br />PHONE: 749-3348 ~ <br /> <br />,'~1763 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: HO <br />SITE EVALUATION NUMBER: 40263 <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br /> <br />SITE <br /> EVALUATION, <br /> <br /> 'DUE <br />PAYEE: <br />RECEIVED BY: PB ......... ~:: <br />SEE ATTACHED DOCUMENT <br /> <br />QUANTITY AMOUNT <br /> I $265.~0 <br /> <br /> RECEIPT NO: <br />TYPE: CHECK t: 0 <br /> <br /> NOTE: THIS DOES NOT <br />ONSI'RUCTION PERMITS MUS' <br /> <br />REMARKS: <br /> <br />DONALD E. <br /> <br />$265.00 <br />$265.00 <br /> $0.00 <br /> <br />$0.00 <br /> <br /> ONi!THIS PARCEL. PLANNING AND <br /> 8EF'TIC INSTALLATION BEGINS. <br /> <br />SE. OKAY FOR S~ARD~YST~': WITp'i~ TI~$~ PITS, & NO ~ER DO"NSLOF'E. <br /> WOODLEY, MARION COUNTY BUILDING OFFICIAL / BY <br /> <br />OFFICE COPY <br /> <br /> <br />