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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLOG, NO. 225 <br />220 I~tlGH'STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 EM. - 8:00 A.M. <br /> <br />I em performing WOrk on a property i own or occupy, <br />I am a registered builder OR ( ) the authorizod representative <br />of a registered builder. <br />The work will be performed by a registered builder. <br />Other <br /> <br />SIGNATURE OF APPLICANT[ <br /> DATE: <br /> <br />02/12/90 TINE: 15:11.~20 <br /> <br />RIGDON, ROBERT & MARY <br /> <br />40368000 <br /> <br />CATEGORY: <br /> <br />OCCUPANGY: <br /> <br />RESIDENTIAL <br /> <br /> 21811 COLE LN <br />AURORA <br /> <br />OR 97002 <br /> <br />NE <br /> <br />NARION COUNTY NO <br /> <br />PHONE: 678-5557 <br /> <br />WIDTH: OEPTI4: <br /> 90 183 <br /> <br />SECTION; <br /> <br />AREA: <br /> <br />11 <br /> <br /> SITE NUMBER: <br /> RA~UATION: <br /> <br />4S IRREG.~T: 1N <br />SF YES <br /> <br /> 9432 <br /> <br />ZONE: <br /> <br />COnN~n: EFU <br />YES <br /> <br />MAP: <br /> <br />TYPE.' ON-SITE SENAGE <br /> <br />PERIVIIT OR APPLICATION <br /> <br />CONTRACTOR, NO. <br />RIGBC¢4, ROBERT & MARY <br />,,~AME <br /> <br />PHONE: 678-5557 <br /> <br />8021910 <br /> <br />EATER SUPPLY: <br />TEST HOLES READY: <br />SITE EVALUATION NUIVlEER: <br />EXISTING TANK SIZE: <br />E}<ISTING DPJ~IN FI'EED LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROO¢4S: <br /> <br /> ITEM C;¢JANTITY AF]OUNT <br /> REPAIR- ~%JOR 1 $80.00 <br /> <br /> .TOTAL' ASSESSED FEES $80. O0 <br /> PREVIOUS RECEIPTS $0.00 <br /> THiS RECEIPT, $80,00 <br /> <br /> ~A~CE ' ~E $0. O0 <br /> <br /> PAYEE: ~BLIC ~Rl~ CO . , RECEIPT NO~ 23236 <br /> RECEIVED BY; PR ~ ~ ........ .... '.~PE.~' IN: ~ECK ~: 0 <br /> <br /> ~EE ATTACHED ~U~T FOR RE~ F ~SZTE S~AGE SYST~. <br /> <br />FO~[N6 ~T 8E ~PL~ED... IT '[S' ~E..,R.~[B[L[~ OF ~E~ APPL[C~T TO ~RE ~AT <br /> <br /> P~ R~I~: BY__ OATE~zL~_ CITY JURISDICTION, BY DATE <br /> <br />¢o~ue~,~*s.s~ REV.~*~ OFF~CE COPY <br /> <br /> <br />