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MARION COUNTY BUILDING INSPECTION <br />SENATOR SLDG 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 />Other <br /> <br />LOFDAHL, LOU TSE <br /> <br />SIGNATURE OF APPLICANT <br /> <br />TAX LOT <br /> <br />0,~TE(~On ~RES I DENT I AL <br /> <br />OR 97O02 <br /> <br />NE <br /> <br />~HONE: 6?8-2300 <br /> <br />SUBDIVISION <br /> <br /> SITE NUhfSER: <br /> VALUATION: <br /> <br />6471 <br /> <br />LOT BLC~ ~,, K <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />CONTRACTOR, NO. <br />LOFD~L, <br /> <br />PHONE: 678-2300 <br /> <br /> 21 4S 1N EFU 6 <br />5 . O0O0O AC YES NO <br /> <br /> EXISTING DRAIN F~ELD LINES: <br /> <br />AREA <br /> <br /> QUANTITY AMOUNT <br />ANNUAL E~AL. ~ T~P OR H[~HP MH 1 $60.00 <br /> <br /> TOTAL A.~ESSED FEES <br /> PREVIOUS RE.EIPT,~ <br /> THIS R~OEIPT <br /> <br /> BALANCE DUE <br /> <br /> CL <br /> <br />SEE ATTACHED DOCUNENT FOR REQUIRENENTS OF ON-S~TE SENAGE SYSTEM. <br />~ THIS IS A YALIB~PE,~'4IT * THIS PER~IT EXPZRE~ 360 BAYS EBON ZTS ZSSUE BATE. IF <br /> <br />$60.00 <br />$60.00 <br />$0.00 <br /> <br /> $0,00 <br /> <br />REMARKS: SEPTIC CHECK FOR HARDSHIP R~6373 ~ ~ <br />DONALD E. WOODLEY, MARION COUNTY BUILDING OFFICIAL / BY ........................... ~ <br /> <br />OFFICE COPY <br /> <br /> <br />