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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: 588-8147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 888-7904 <br /> <br />I,)A'fb: 09/1'2./91 'f'IME: 11:34:25 <br /> <br /> ROBIN~OA, RANDY & ,5~E, AN <br /> <br />SITUS ADDRESS: <br /> <br /> DATE' <br />CONSTRUCTION TYRE: <br /> <br /> 20822 ULIV~ [ b. AL) Mf) Nb. <br />AURORA OR 97002 <br /> <br />CONTRACT CITY UGS <br />IVLAN I [JN (;OUN I Y N[.~ <br /> <br />MAILING ADDRESS: <br /> <br />SU~3DiVtSION <br /> <br /> PHONE: r~'/8'-b898 <br /> <br />LO'f St. OCK: SECTION <br /> <br />WIDTH DEPTH AREA <br /> <br /> TOWNSH P: <br /> <br />2.4 b Ar_; <br /> <br />SI']'E NUMBER: <br /> VALUAT i £~: <br /> <br />RANGE: <br /> <br /> RREG LOT <br /> <br /> CATEGORY: <br /> UNKNOWN <br /> <br /> OCCUPANCY: <br /> <br />OCCUPANT LOAD: <br /> <br /> 95?? <br /> <br />ZONE :MAP <br /> EP'U <br />CORNE~o <br /> <br />TYP~: ON-SIf'g SEWAGE <br /> <br />PERMIT' OR APPLICAFION <br /> <br />CON'f'P~C'I'OR, NO. <br />F:TOB[N,LSON, RANDY & SUSAN <br />SA~E <br /> <br />PHONE; <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />Si'FE EVALUAfION NUMBER: <br />E~iS'r~NG 'lANK SIZE: <br />EXISTING DRAIN F~ELO LINES: <br />SEP'~1C TANK PUMPED: <br />PREVIOUS NO. BEDRgX.~S: <br /> <br /> 1rEM <br />REPAIR - MAJOR <br /> <br />'[OTAL ~ED FEES <br />PR~WiOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY A~C~Nf <br /> 1 <br /> <br />$80,~0 <br />$80.00 <br /> <br />BALANCE DUE: $0_00 <br /> <br /> PAYEE: ,, RECEiRT NO_+ <br /> RECEIVED BY: c'1 TYPE: CHECK ~: <br /> <br /> SEE A'f"fACHED DOCUMENf FOR RE(,'~J~REfl4ENTS 0f'= ON-SITE ~ENAGE <br /> <br />~ TH[¢ IS A VALID PE~IT * TH[8 PE~[T ~PiR~ 380 ~ F~ ITS l~g ~TE. IF <br />~T~CTI~ FAI~ TO ~EET ALL R~IR~T~ OF STATE ~ ~0 ~RI~ ~NTY BUiLDiNG <br />Z~ING OROIN~C~. THIS PE~T ~ALL BEdE NULL. ~O ~[D. <br /> <br />REMARKS; 5~' REPAiR/REPLACEMENT R'~69'78 /~ ~ <br />UCNALD E_ ~3ODLEY, IVlARION COUNTY BUILDING OP'P'iOiAL / BY ~ <br /> <br />FORM # MC 15-56 REV. ~/90 OFFICE COPY <br /> <br /> <br />