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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 /> am performing work on a property I owr~ or occupy. <br /> APPL CANT <br />I am a registered builder OR ( ) the authorized representative SIGNATURE OF <br />of a registered builder. <br />The work will be pedormed by a registered builder. <br />Other <br />I have read and agree to the terms stated on the reverse aide of DATE: <br />this document. <br /> <br />BENNETT, VERA 40159-815 COMMERCIAL <br /> <br /> 22779 AIRPORT RD NE ~O~RACT CITY: ~UGS; ~OCCUPANT LOAD: <br /> AURORA OR ~7002 HARION COUNTYL NO <br /> <br />15111 NE MULTNOMAH <br />PORTLAND, OR 97230 SITE NUMBER: 93-0044~ <br />PHONE: 254-7110 <br /> ! VALUATION: <br /> <br /> ~ , , i YES ~ NO <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERHIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />BENNETT, VERA <br />15111 NE MULTNOMAH <br />PORTLAND, OR ~7250 <br />PHONE: 254-7110 <br /> <br /> WATER SUPPLY: PW <br /> i TEST HOLE3 READY: 2-5-g~ <br />45135 i SITE EVALUATION NUMBER: <br /> I EXISTING TANK SIZE: <br /> i EXISTING DRAIN FIELD LINES: <br /> ~ SEPTIC TA~K PUMPED: <br /> ~ PREgIOO~:NO,:8EOROOMS: <br /> <br /> ITEM ; > ~: QUANTITY AMOUN1 <br /> SITE EVAL. - FIRST i ":i 1 $265.00 <br /> <br /> F~ES $265. O0 <br /> ~T~ $265. O0 <br /> ~/ $0. O0 <br /> <br /> $0. O0 <br /> <br />'PAYEE: ~, ,: , : RECEIPT NO. <br /> RECEIVED BY. P8. ~.~ ._~ ;:: : , TYPE: CHECK l¢: 0 <br /> SEE ATTACHED DOCUHEN~ FOR REQuIREMENts <br /> <br /> NOTE: THIS DOES NOT' O~ THIS PARCEL. PLANNING AND <br /> ONSTRUCTION PERMITS HgB~ BE OBTAINED BEFORE~ BUILDING OR SEPTIC INSTALLATION BEGINS. <br /> <br />REMARKS: SE FOR PLANNED pARTITION. APPR. FOR STO 8Y$ <br />~ONALO E. WOOOLEY, MARi'OR coUNty BUILDINh 6FFICI~L / BY <br /> <br />OFFICE COPY <br /> <br /> <br />