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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDC~' NO :~25 <br />220 HIGH STREET N'E <br /> SALEM, OREGON 97301 <br /> <br /> PHONE, 588-5147 8::00 - 4::30 <br />24 HOUR CODE-A-PHONE;: 588-7904 <br /> <br />ow~:h/E: 081 q i/9(;} ! LNIE: <br /> <br /> D~f xrJ f Sf~.fE P,aR~ <br /> <br />8~13;29 <br /> <br /> A'¢ FClILL R05~. NO SAMftAM HWY SE <br />L.X:{ ! ROi I QR 9?342 <br />USE Of- BUILDING <br /> <br /> CONTBACT CIT1 <br /> <br />MARION COUN ~ Y <br /> <br />UGB <br /> <br />SUBDIVISION <br /> <br /> .. LV~N FALL5 BNY SE <br />SUBL f M,I fy Ol-~ 9738b <br />~H::DN E: 8 73-8b, 8 I <br /> <br />I O~ BLOCK SECTION <br /> <br />NO <br /> <br />CATEGORY <br /> <br /> Ct_/MMLRC fm._ <br />OCCUPANCY <br /> <br />NO <br /> <br />I y',~,k.: ONe5 ~ 1 b 3ENAGE <br /> <br />P~:Rr4II (.)R APPLfC~TI(,)N NO: 9028425 <br /> <br />HATER ~PPLY: <br />~ESF HOLES REAOY: <br />~i1~ EVALUATION NUMBtR; <br />~,~<iSriNG TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC lANK PUMPED: <br />PREVIOUS NO~ BEDROOm3; <br /> <br /> i rEM <br />~:{ ~ QN:3i~E SYS ( l JOg GAL <br />ADDi I I()N&L 5URCH,~E' ~ (~3JBSURFACE <br /> <br />~AYEE: [)~fROJF 5rAfE P~RK <br /> <br />'fOlaL A~ESSED PEES <br />PRE¥1OUS REC~!Pt'S <br />~HtS RECEIPT <br /> <br />OUAN !' i ¥ Y Avl( <br /> <br />f ! 6h. rid <br /> $ooo <br />'~ !6b. <br /> <br />BALANCE DUE AT.i_ <br /> <br />RECEIPT NO, 2?998 <br /> <br /> RgCDIYEB BY: PR TYPE: CK CHECK ~t r38182 <br /> <br /> ~Eb A¥fACHED DOOUM~Ni FOR REQUiRemENTS OF ON~i'fE ~NAGE SYSfE~, <br /> <br />~ THIS iS NOT A PER~iT_ THiS APPLiCAtION I~UST GO THR¢~f~ A REiV1E~ PROCP_~ ~ERE THE <br />~LL~ZN~ ~51 8E ~PL~t'~D. IT IS THE R~SiBILiI'Y OF THE APPLI~T TO ~RE THAT <br />ALL NEC~ iNF-O~i~ H~ BE~ P~VIOED. <br /> <br />REM,aRKS: tVlAJOR REPAIR <br /> <br />CiTY JLR!50iCflO~- ~Y <br /> <br />OFFICE COPY <br /> <br /> <br />