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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 ar~ 8 register,Jd" builder OR ) the authorized representative <br />of a registered builder. <br /> <br />SIGNATURE OF APPLICANT: <br /> DATE: <br /> <br /> DAI'g: 12/13/90 'liME= 9:51258 <br />OWNER: <br /> <br /> K~JOX, MICHAEL ~ & LINDA L <br />SITUS ADDRESS. <br /> <br />RE~I 0N.N l J, AL <br /> <br /> 6691 PE'f'ER~ ROAO ~ <br />AUI~¢ViLLE OR 97325 <br /> <br /> CONTRACT CITY UGB OCCUPANT LOAD <br /> <br />MARION COUN [ Y NO <br /> NO <br /> <br />SUBDIVISION <br /> <br />10965 JAME~ WAY DRIVE <br />AUfv~SViLLE 97325 <br />PHONE: 749-2155 <br /> <br />LOf: BLOCK: <br /> <br />WIDTH: DEPTH: <br /> <br />SE <br /> <br />SECTION TOWNSHIP <br />AREA: UNITS <br /> <br /> SiTE NUMBER~ 9586 <br /> VALUAFiON: <br /> RANGE ~ONE MAP. <br />8S I~ AR 48 <br />AC Y~ NO <br /> <br />fYPE: ON-SiTE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: 29127 <br /> <br />O~,,~N'I'RACI'OR, NO. <br />KNOX, MICHAEL G & LINOA L <br />10965 JAMES NAY DRIVE SE <br />AU~'¢GVLLLE 9?325 <br />PHONE: ?~9-2155 <br /> <br />~ATER SUPPLY: PiN <br />TEST HOLELS READY: <br />5i'I'E EVALUATION NUMBER: 22305 <br />E~IS'FING 'rANK ~IZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDR%)OIVP¢: <br /> <br /> ,[ 'f',E~ r,.JUAN 'f' i 'f'Y AMOUNT <br /> STANDARD ON-SiTE SYSTEM 1 $165.00 <br /> <br /> '[OTAL A2S~ED FE~ $'165_O0 <br /> PRE'~',/iOUS RECEI Pl'$ $1 (55.00 <br /> 'rN~8 RECEIPT $0- O0 <br /> <br /> BALANCE DUE $0- <br /> <br /> PAYEE: RECEIPT NO.' <br /> RECEIVED BY: CL .............................................. i,,,,,i ............. ,,. ...................................... TYPE: CHECK ~: O <br /> <br /> 5EF,,f: A'I"IACHED BOCUMENT FOR REQUiREJ~EN'I'S OF' ON-SJ,'f'E SEIA,AGE SYS'f'EM. <br /> <br /> ~: THIS IS A VAL[D PER:NIT * TH'f8 PER,lIT E,~PiRf¢.~ 380 OA'Y'~ <br />CONSTRUCTION FAILS 'i'D MEET ALL R.Ef~.~I~.P_'~BT8 Of; STATE ~ AND [¢tARION COUNTY BU[L,OING AND <br />ZONING ORDINANCES, THiS PEF'~4~,T 8HALL BECOf~E NULL AND <br /> <br />REMARKS-_ STN[:) SYS'IE¢4 R.~4'F28 <br /> <br />DONALD E. NOOOL, EY, MARION COUN'fY BU!LPlNG OFPICIAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC 16,56 R~V. 4/'90 <br /> <br /> <br />