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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 pesforming work on a ¢roperty 1 own or occupy. <br />I sm ~ regislered builder OR the authorized representative <br />of a registered builder, <br />f'ho work will be performed by a registered builder. <br />Other <br />I h~ve read and agree to the terms stated or1 the reverse side of <br />this docL~ment, <br /> <br />SIGNATURE OF APPLICANT: <br /> (;>ATE: <br /> <br />ow,ul~'f'E: 08/28/91 'f'tf'.4E.: 12.-1:~.:1t TAX LOT 'CATEGORY: <br /> <br /> ROSiN~, ~ANDY & ,~J:AJ,SAN <br />SITUS ADDRESS CONSTRUCTION TYPE ' OCCUPANCY: <br /> <br />UNKNOWN CLA~ <br /> <br /> 20822 OLMS'I'EAD RD <br /> AURORA <br /> <br />gSE OF BUILDING <br /> <br />SAME <br /> <br />PHONE: 6'18-5898 <br /> <br /> BLOCK: <br /> <br /> NE <br />OR 9Y002 <br /> <br />SECTION TOWNSHIP. <br /> <br />CONTRACT CiTY i UGB; ,OCCUPANT LOAD <br /> <br />MARiCAI ¢DOUN I'Y N~ <br /> <br />SUBDIVISION <br /> <br />SITE NUfVtSER: <br />VALUA'F I r.,,.Y4: <br />RANGE ZONE <br /> <br />MAP: <br /> <br /> UNITS: <br /> <br />2.45 <br /> <br />RREG LOT: lW !CORNER EFU <br /> NO ! NO <br /> <br />4 <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIt OR APPLiCA'IION NO: <br /> <br />CONTRAC'rOR, NO. <br />ROSiN,SON, RANDY & SUSAN <br />SA~4E <br /> <br />pHrJNE: 878-~5898 <br /> <br />9034.766 <br /> <br />WATER SUPPLY: F~ <br />TES'F HOLE~ RP-ZADY; <br />SITE EYALUAI'ION NUMBER: <br />E.XIS'FING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC 'rANK PUI'4PED: <br />PREVIOUS NO. BEDROOMS: <br /> <br />I['EN (;~AN'T'i'f'Y .advCJUNI <br />REPAIR -- MAJOR 1 $80_00 <br /> <br />TOI'AL A~EO FEE~ <br /> PRE¥IOUS RECEIPTS <br /> 'f'Hi~RECEiP'¥' <br /> <br />$80.00 <br /> $o_0o <br />$80.oo <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: ROB iNSC~, RANDY & SUSAN RECEIPT NO: 38858 <br />RECEZVEO BY: ~ ........................................... ;.,.:,;L,.;.: .............. Z;2 ..... . TYPE: CK C~ECK ~: 2444 <br /> <br /> SEE ATTACHED DOCUNEN'f' FOR R~QUiREI~IP..,NTS OD ON~SI'f'E ~AGE SYS'FEt4. <br /> <br />* THiS IS NOT A PER~IT. THIS AP~I~TI~ ~ST ~ TH~ A R~I~ P~ ~ERE THE <br />~LL~ING ~T BE ~PLETED. IT :~iS ~E R~iSiLiTY OF THE APPLI~T TO ~RE THAT <br />ALL NB~ iNFO~TI~ H~,B~ P~IDED. <br /> <br />REI',AARKS: ~ REPAIR/REPLACEMENT R-8978 <br /> <br />CI'FY JURI8DIC'flON= BY 0AtE <br /> <br />FOR~ ~ ~c ~5,s~ REv. 4/~0 OF FICE COPY <br /> <br /> <br />