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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 /> 23766 3RD ST~ (BUTTEVILLE) NE CONTRACT CTY: UGB: OCCUPANT LOAD: <br />AURORA OR 978~2 MARION COUNTY NO <br /> <br />: MAILING ADDRESS: SUBDIVISION: <br /> <br /> 23764 3RD ST (BLrrTEVILLE) <br /> AURORA OR 97002 SITE NUHBER-- 94-~1818 <br /> PHONE: 678-5639 VALUATION,': <br /> <br />TYPE: ON-SITE SEWAGE WATER SUPPLY: PW <br /> TEST HOLES READY: <br />PERHIT OR APPLICATION NO: 54844 SITE EVALUATION NUMBER: <br /> EXISTING TANK SIZE: <br />CONTRACTOR. HO. EXISTING DRAIN ~IELD LINES: <br />CLARE~ DANIEL E. & VIRGI~AG ~ ~STIC.~ANK--~UHI-ED: <br />23764 SRD ST (BUTIEVIL, L~ <br />AURORA OR 97082 <br />~FHONE: 678-5639 <br /> <br /> ITK" ? ~ OUANTITY <br />SITE EVALUATION~ <br /> <br /> PAYEE: <br /> RECEIVED BY: PB <br /> <br /> SEE ATTACHED DOCUMENT <br /> <br />NOTE: tHIS DOES NOT ~;RL <br />ONS1RUCTION PERMITS <br /> <br />RECEIPT NO: <br /> <br />AMOUNT <br /> $225.80 <br /> <br />$225.00 <br />$225.00 <br /> $0.00 <br /> <br />$0.80 <br /> <br />TYPE: CHECK ~: 0 <br />fSTEM. <br /> <br />PARCEL. PI.ANNING AND <br />INSTALLATION BEGINS. <br /> <br />DONALD E. WOODLEY, MARI~H'COUNri~ BUtl..DII'IG O~FICiAi / BY . ........................................ <br /> <br />OFFICE COPY <br /> <br /> <br />