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MARION COUNTY BUILDING INSPECTION <br />SEN/~TOR BI'DG. NO. 225 <br />22b 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 />f am a registered builder OR ) the authorized representative <br />of a registered builder. <br /> <br />Other__ <br /> <br />LEA, HARVEY YX~ ~.OT: :C~¢660BY; <br /> <br />RESI DEN T i/ <br /> <br /> 10253 MILL CREEK ROAD SE <br />AUM~VILL~ OR 97325 <br /> NO OCCUPANT <br /> <br />MAILIN~ ADDRESSi <br /> <br />SUBDIVISION: <br /> <br />$ i TE. NOMBER~- 9.2=01.922 <br /> VALUAT iON: <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />LEA, HARVE~f <br /> <br />40108 <br /> <br />TE~T HOLE~ READY: <br />SITE ~/ALUATiON NUMBER: <br />P. XlS'rlNG TANK SIZE: <br />~)(ISTiNG DRAIN FIELD LINESt <br />SEPTIC 'rANK PUMPED: <br />PREViOJS NO- BEDROOf,~: 3 <br /> <br /> i T EM qUANT I TY AMOUNT <br /> ALTERAT 10N 1 $210. 00 <br /> <br /> I'OTAL A68E'SSED FEF_..8 $210.00 <br /> PR~ i~S RECEIPTS $130.00 <br /> THIS RECEIPT $80.00 <br /> <br /> bA~CE ~E $0.00 <br /> <br /> PAYEE~ ~ & M ~s'r~cT~ RECEIPT NO: 42281 <br /> RECeiVED BY= CL ~' TYPE~ CK ~ECK ~t 2544 <br /> ...................................... ._._~ ~._.~ <br /> <br /> SEE A'r'rA~EO ~M~'r FOR REdiReCTS OF ~-~[TE S~GE <br /> <br /> = TH[8 iS A VAL~O ~[T ~ ~ PE~T ~P~R~ 360 ~ <br />~CT~ FA~ TO ~T ALL ~R~T8 OF STATE ~ ~D ~R[~ ~NTY BU[LDZN6 ~D <br />Z~ZN60~N~C~, TH]~ ~f ~ALL BEdE NULL ~D <br /> <br />REMARKS= AL'rERA'riON <br /> <br />DONALD E. ~NOODLEY, MARiON COUNTY BUILDING OFFiCiAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC 15.56 REV. 4/90 <br /> <br /> <br />