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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. '~25 <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 ar'n perlorming work enaproperty I own or occupy. <br />) I 8m a registered builder Ol~ ( ) the authorized representative SIGNA"FURE OF APPLICAN <br />((~// of a registered builder, <br /> Other. <br /> ) I have read and agree to the terma 8tared on the reverse side of DATE'. <br /> [his document. <br /> <br /> DATE: 02/01/88 ']-:[ME: 12;i3--~p , <br /> <br /> ATKINSON, GERTRUDE [ <br /> <br /> 7821 TERRANCE LN <br /> AU~SV I L L E <br /> <br />MAILING AODRESS: <br /> <br /> PHONE: 749.~2697 <br /> <br />LOT: ~gOOK: <br />WiDII H: :DEPTH: <br /> <br /> SITE NUMBER: 3593 <br /> VALUATION; <br /> <br /> o~ ! o¢ ~N ' A~ <br /> <br />0.88000 I AC ~ NO ! NO <br /> <br />TYPE: ON-'SiTE SEWAGE <br />PERHIT OR APPLICATION NO: 9006504 <br /> <br />CON~R.AC,OR, NO. 3491~P-2 <br />STAYTON SEPTIC SERVICE ~,~D <br />4/,55 STAYTON SC,D DRIVE, SE <br />STAYTON, OREGON 9?383 <br />~HONE: ?69-2302 %,, <br /> <br />WATER SUPPLY: PM <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER; <br />EXISTING TANK SIZE: <br />E. XISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: NO <br />PREVIOUS NO. BEDROOMS: 2 <br /> <br /> I TENI QUANT I TY AMOUN 7' <br />REPA I R <br /> <br /> ,: PREVIOUS:: RECEIPTS $0_ O0 <br /> TH~S: RECEIPT <br /> <br /> .BALANCE DU:E <br />PAYEE; ATKINSON, G 'RECeiPT NO: <br /> <br />SEE ATEACHED DOCUMENT FOR REQUZREHEN%S OF:ON-~:~'~E:;~E~GE,SYSTE~. <br /> ~S <br />FOLL~ZNG <br />ALL NEC~ ZNFO~TZ~ <br /> <br />PLAN REVIEW: BY :: CITY JURISDICTION; DY 0A'T'E <br />RENIARKS: SEPTI] INSTALLER DISCOVERED T~K NEEDED ~PL~GED <br /> <br />fo.~ ,~ MC ~.~ .~v e/8~ OFFICE COPY <br /> <br /> <br />