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MARION COUNTY BUILDING INSPECTION <br /> <br />SENATOR BLDG. NO. 225 <br />220 HIGH. STREET NE <br />SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 PM. - 8:00 A.M. <br /> <br /> am performing work on a property I own or occupy. <br />am a registered builder OR ( } the authorized representative <br />el a registered Dullder, <br />The work Will be performed by a registered buJJder. <br />Other .... <br />I have read and agree to the terrns stated on the reverse side of <br /> <br />DATE: 03/0?/90 TINE: 11=22:05 <br />OWNER: <br /> <br /> I~OORE, KENNETH <br /> <br />TAX LOT: <br /> <br />CONSTRUCTION TYPE: <br /> <br />CATEGORY: <br /> <br />OCOUPANDY: <br /> <br />RESi DENTIAL <br /> <br /> 6891 PETERS ROAD SE <br />AUMSVI LLE OR 9?325 <br /> <br />USE OF BUILDING: <br /> <br />CONTRACT CITY: UGB: <br />MARION COUNTY NO <br /> <br />MAILING ADDRESS: ....... SUBDIVISION: <br />9952 BR01,"'NELL DRUVE SE ~ / ~¢ ~..~ -,/.//z~'~ <br /> PH~E:..-74'9='9'977''~.-.~ ] O ///~ ~ S~TE NU~ER: 9586 <br /> '"-~ ...... ~ ~%~~ f VALU AT Z ON: <br /> <br /> 19 8S 1N AR <br /> ?. AC YES NO <br /> <br />'TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: 9022305 <br /> <br />CONTRACTOR, NO. <br />NC'ORE, KENNETH <br />9952 BRONNELL ORUVE SE <br />SALEM 97325 <br />PHONE: 749-!977 <br /> <br />WATER SUPPLY: <br />TEST HOLES READY:~~ <br />SiTE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EX{STING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO- <br /> <br /> iTEN QUANTITY AMOUNT <br />SITE EVALUATION~ FIRST LOT 1 $175-00 <br /> <br /> ~OTAW'ASSE'SSEDFEES $175.00 <br /> R'EViOUS RECEIPTS $0.00 <br /> THIS RECEIPT $175.00 <br /> ~ BALANCE.DUE $0.00 <br />PAYEE= MOORE, KENNETH ~ \ , RECEIPT NO: 23649 <br /> <br />SEE ATTACHED DOCUMENT FOR REQUIRD'4~NTS'OFON-SITE:'SENAGBSYSTBM. <br /> <br />NOTE: THIS BOB NOT GRANT OR,I~PLY PEF~IISSIONTOBUILDCf4, THIS PARCEL. PLANNING AND <br />CONSTRUCTION PERNITS ~4UST BE CBTAINEDBEFORE BUILDING ORSEPTIC INSTALLATION BEGINS. <br /> <br /> PLAN REVIEW: BY DAT~ CITY' JURISDICTION; BY DATE <br /> REMARKS: SE R~2725 <br /> <br /> <br />