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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-$147 <br />CODE-A-PHONE 4:30 P,M. - 8:00 A.M. <br /> <br />DATE: 06/2?/88 TIME: <br /> NARD. PETE <br /> <br />3.:45:47p <br /> <br />fax LOT. (GATEGORY: <br /> <br />RESIDENTIAL <br /> <br /> 19811 OLM~TEAD RD <br />AU ~ORA OR 97002 <br /> <br />NE <br /> <br /> CONTRACT CITy <br /> <br />NAR ION.. OOUN]7_Y <br /> <br />UGB i OCCUPANT LOAD: <br /> NO ................. , · 2 <br /> <br /> SA~E <br /> <br /> PHONE; 878-2656 <br /> <br />t. OT BLOCK <br /> <br />TYPE.* ON-SITE SEWAGE <br /> <br />PER~IT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />V'/ARD, PETE <br /> <br />PHONE: 678-2656 <br /> <br />SECTION: TOWNSHIP <br /> <br /> 19 <br /> <br /> 20,0000 <br /> <br /> 4S <br /> I~REG. LOT CORNER; <br /> AC NO NO <br /> <br />WATER ~UPPLY: ~ <br />TEST HOLES READY: <br />SITE EVALUATION NUF~ER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: 400 <br />SEPTIC TANK PUMPED: WILL BRING IN <br />PREVIOUS NO. BEDROO~4S: 2 <br /> <br />SITE NUMBER.' <br />VALUAT ION *. <br />RANGE ZONE'. MAP; <br /> <br /> . 1N ........... E.F.U 6 <br /> <br /> ITEN QUANTITY ANOUNT <br />AUTHORIZATION NOTICE - FLD. VISIT 1 $105.00 <br /> <br />TOTAL ASS~ED FEES <br />PREVIOUSRECEIPTS <br />THIS ~ECEIPT <br /> <br />[105.00 <br />105.00 <br /> $o.oo <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: RECEIPT NO: <br /> <br />RECEIVED BY: J8 TYPE: CHECK ~: <br /> <br />SEE ATTACHED DOCUMENT FOR RE(~JIREHENTS OF ~-SITE ~GE SYST~, <br /> <br />~ ~IS IS A VALID ~IT ~ ~IS ~IT ~[~ 360' ~ F~ iTS I~E ~TE, IF <br />~'t'~I~ FAI~ TO ~ A~ RE~I~ ~ STA~ ~ ~D ~I~ ~ BUILDING <br />Z~Z~ ORDZN~, ~ZS PE~T ~L <br /> <br />REFL&RKS; AUTH R~6324 <br />DONALD E. WOODLEY, MARION COUNTY BUILDING OFFICIAL ~ BY <br /> <br />o~ ,, ~c ~r,e~e, ~ev ~;/s7 OFFICE COPY <br /> <br /> <br />