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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:: 588-5147 8:00 - 4::30 <br />24 HOUR CODE-A-PHONE:: 585-7904 <br /> <br />of a registered buUder. <br /> <br />this document <br /> <br /> 14843 e~S AVE ~ '666i~C¢d,¢9 IO~ ........ ~=-= ...... 5~6~'[6X6 <br />AU~ OR 9?002 <br /> <br />tb~Pr~ ..... <br /> <br />I SE-~TI(~ [TOWNSHIP <br /> i UNITS <br /> <br />RANGE ? ZONE ! MAp <br /> NO. J .. NO <br /> <br /> fYPE: ON-SI'IE SENAGE <br /> <br />PERNiF OR APPL~CAFIC~'4 NO: <br /> <br />CON FRACFOR. NO. <br />BLA1CHFORD, DON <br /> <br />8034932 <br /> <br />WAIER ~::~JPPLY: ON <br />1E5~ HOLES READY: <br />sire EYALUArlON NUIV~ER: <br />EXiSFING lANK SIZE: ~'~ <br />E.,Xi5FiNG DRAIN FIELD <br />S~PFiC TANK PU~PED: 2~]5~88 <br />PREVIOUS NO. <br /> <br /> ITEN <br />E~ISfiNG SYSFEN EVAL. RPF. <br /> <br /> TOIALA.E~,E. SSED <br /> PREViCUS RECEIPTS <br /> THiS'RECEIPT <br /> <br /> BALANCE DUE <br /> <br />PAYEEt BLArCHFORD, <br />RECEIVED BY: c"l ........................... &,; <br /> <br />QUANIIfy AMOUN~ <br /> 1 $100.00 <br /> <br /> $o,oo <br />$~00-0o <br /> <br />$0,00 <br /> <br />,INVOICE NQ: 36821 <br />IN CHECK ~; 0 <br /> <br /> SEE AFTACHED DOCUPqENI POR REQUiREI~4ENTS oF'O~sf I'E SEWAGE SYSTEM. <br /> <br />I=OLLOI~I~ IvfJST E TE :~ T, TH ~?'REE~P~]iN~IBiLiTY OF THE APPLiC~IT TO ~S~IJt~E THAT <br />ALL NI~C[~,ARY INFORi~tATION _~.~. ',.,Ei~ PR~IDEDJ ~./,;" ~ . <br /> ¢ '" :.'/, ,,:.-. <br /> <br />RENARKS; LOAN REPORI <br /> <br /> <br />