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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREE~T NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 558-5147 <br />CODE-A-PHONE 4:30 P,M. - 8:00 A,M. <br /> <br />Other. <br /> <br />0ATE '.' 05/16/88 TIME: 1:43; 12p <br /> <br />OWneR: HAZ ELI~DGD, LEE <br /> <br />SITUS ADDRESS~ <br /> <br /> 9413 GOLF CLUB RD <br /> AUMSV I LLE <br /> <br />DYE OF BUILDING: <br /> <br />MAILING AODRPSS: <br /> <br /> REAL ESTATE PROF <br /> PHONE; <br /> <br />S~GNATURE OF APPLICANT; <br /> <br />LOT. WLOCK: <br />WIDTII: DEPTH: <br /> <br /> TAX LOT: 1001 ; C^TEGOn¥: RESI DENTI AL <br /> <br /> SE <br />OR 97325 CONTRACT CITY: i UGB'. <br /> ~RI~ COUNTY { NO = <br /> <br /> 3 <br /> <br />789-3448 <br /> <br /> SITE NUMBER: 4432 <br /> VALUATION: <br /> <br /> ] SECTION: TOWNSHIP: RANGE; i ~ONE: <br /> <br /> MAP: <br /> 4 9S 1W i EFU 50 <br />AREA: 2.00000 UNITS: AC : IRREG. LOT: yES <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: 9008514 <br /> <br />CONTRACTOR. NO. 34916P-2 <br />STAYTGN SEPTIC SERVICE <br />41155 STAYTON SCIO 0RIVE. SE <br />STAYTON. OREGON 9?883 <br />PHONE~ ?89-2302 <br /> <br />HATER SUPPLY: <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />IEXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED= <br />PR~-qlOUS NO. BEDROOMS: <br /> <br />[TEN ~UANTI~TY AMOUNT <br />REPAIR - ~INOR O(~ $55.00 <br /> TOTAL A~>t;3~ED FEES $55.00 <br /> PREVIOLIS RECEIPTS $0.00 <br /> THIS RECEIPT ~55_00 <br /> <br />PAYEE: STAYTON SEPTIC SERVICE <br />RECEIVED BY: ON <br /> <br />BALANCE DUE $0.00 <br />  RECEIPT NO: 9170 <br /> TYPE: CK CHECK ~: 9695 <br /> <br />SEE ATTAC~ED DOCUMENT FOR REOUIRE]VlENTS OF ON-SITE SE. WAGE SYSTEH. <br /> <br />~ THIS IS NOT A PERt, lIT. THIS APPLICATION I~dST. GO THROU6~ A REVIEW DROCES~ W~-IERE THE <br />FOLLOWING MUST 8E COf~PLETED. IT IS THE RESPONSIBILITY OF THE' APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORMATION HAS BEEN PROVIDED~ <br /> <br />SEPTIC TANK REPAIR R;~8079 <br /> <br />CITY JURISDICTION: BY <br /> <br />DATE <br /> <br />rG~M ,, ~. ~,.~,.~ .~v 6/e'/ OFFICE COPY <br /> <br /> <br />