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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: 588-7904 <br /> <br /> DATE; 09/13/91 'liME ' 5 0'7 20 , TAX LOT'. <br />OWNER: <br /> ~N I LLAME'T l E NATIONAL FOREST <br /> <br /> MP 0-9 FOREST SERVICE RD NE "b~01 iO~CuPANT LOAE: <br /> IROI~ OR 9'7342 ; , , .,. .. , , , <br /> ......... NO ................ <br /> <br /> HC ?3~zu~ C~'~Y 9?350 N- ~ /~ I ~ ~ ...... <br /> <br />L0~: ~ SECTION: ~ TOWNSHIP: RANGE: ; ZONe: : <br /> <br />W~DTH: DEPTH: AREA~ UNITS'. IRREG LOT; : CORNER: <br /> 5_ 8 AC NO NO <br /> <br />TYPE: ON-SiTE SEWAGE <br /> <br />PERMIT OR APPLiCAI'tON NO: <br /> <br />903515? <br /> <br />CON'fRAC'f'OR, NO, <br />NiLLAMEI"f'E NA'[iONAL FOREST <br />DE'I'ROI1 RANGER DiS'T. <br />HC 73 BOX 320 MILL CiTY 9?360 <br />PHONE: ~b5-694'? <br /> <br />NATER SUPPLY: CN <br />TEST HOLES READY: 9-18--9! <br />SiI'E EVALLIAI'.~ON NUMBER: <br />EXISTING TANK SIZE: <br />EXiSTiNG DRAIN FIELD LINES: <br />SEP'flC TANK PUMPED: <br />PREVIOUS NO. ~EDROOMS; <br /> <br />iTEM ,., QUAN'II'IY AMOUNI <br />EVAL_ - FIRST 1000 GAL DSF (~\ 1 $180.00 <br /> <br />PAYEE: WILI-AME'f"f'E NATIONAL <br /> <br /> ~/ TO'f'AL A~SESSED FEES $180_00 <br /> PREVIOUS RECEIPTS $0_00 <br /> THiS RECEIPT <br /> <br /> BALANCE DUE <br /> <br />FOREST RECEiPI NO: 3?064 <br /> <br />~ECEIVED BY: c"l ................................................................................................................. TYPE: CA. CHECK <br /> <br />SEE Af'TACHED D©CUMEN'f' FOR REQUIREMENTS OF ON~Si'f'E SENAGE SYSTEM_ <br /> <br />NOTE: THIS DOES NOT GRANT OR IMPLY PEI~4IB.SiON TO BUILD ON fHI5 PARCEL. PLaNiNG AND <br />CONSTRUCTION PERt4ITS MUST 8E OBTAINED BEFORE BUILDING OR SEPTIC INSTALLATION BEGINS. <br /> <br /> PLAN REV,E : .......... <br /> <br />FORM # MC 15-56 REV. 4/90 <br /> <br />OFFICE COPY <br /> <br /> <br />