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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 <br />CODE-A-PHONE 4:30 P.M,- 8:00 A,M, <br /> <br />I have read and agree to the terms stated on the reverse side of <br /> <br /> DATE: 08/07/87 TIME: 11:25:56a <br /> HANPTON , KELLY COf~IERI CAL <br /> Sr~US ADDRESS: C0~STR~CTION +¥~E: !OCCUPANCY <br /> <br />, 8673 SHAW S(;dARE RD SE ¢ 'OSe: ~GCSuPANT LOAD: <br /> AU~VILLE OR 97325 ~EI~.,~N~ ......... N0 ,, ' <br /> USE OF BUILDING: ~N0 OF 8EDR00MS: <br /> <br />P.O.BOX 694 <br />AUMSVILLE, OR 97325 <br />PHONE: ?49-260? <br /> <br />WIDTH: DEPTH: <br /> <br /> i SITE NUMBER= 2067 <br /> : VALUATION: <br /> <br /> 49 <br /> <br />i 2.00000 ' AC , NO i NO <br /> <br />TYPE: ON-SITE SENAGE <br /> <br />PEI~fIT OR APPLICATION NO: 3523 <br /> <br />CONTRACTOR, NO. <br />HAMPTON, 'KELLY <br />P.O.BOX 594 <br />AUMSVILLE, OR 9?225 <br />PHONE= 749-2607 <br /> <br />NATER E~JPPLY= PN <br />TEST HOLES RF_.ADY~ <br />SITE EVALUATION NUMBER: <br />ED(ISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC T~K ~MPED: 5-8-84 <br />PR~I~S NO. BED--S: <br /> <br /> ITEN qUANTITY <br />EXISTING SYSTEM EVAL. RPT. 1 $60.00 <br /> <br /> TOTAls: :AS~E:SSED :FEE~ $60 · O0 <br /> PR~'t~S R~EIPTS' $60.00 <br /> R~EI:PT $0. O0 <br /> ' DAncE ~E $0.00 <br /> <br />PAYEE: , ': "R~/IPT NO: <br />RECEIVED BY: J8 ~P~,~'~, . . '~ECK ~; <br />SEE ATTA~EO ~M~T FOR REdIReCTS OF <br /> <br />RENARKS: E.S.R. FOR LOAN <br />00NALD E, NOODLEY, IV[ARION COUNTY BUILDING OFFICIAL / BY <br /> <br /> <br />