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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STF{FET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />t am ~ registered builder OR ( ) the authorized representative <br /> <br />The work will be performed by a registered builder, <br />Other. <br /> <br /> [ CONTRACT CITY[ , UGB: IOCCUPANT LOAD; <br /> <br /> SITE NU~ER= ~3-~542 <br /> F'HONE: S97-..S484 VALUATION: <br />~'E~T~ ~'KE~SR~ ........ ~ ~tTD'~'~ 96~i>T ........... ~"~ ............... 7-~R~ ...................... T~z'F~ .............. <br /> <br />~ . _ ......... ~ ......... I ...... _. <br />;W~OT~: ~EPTH: TAR~ '; UN~T~S ~ IRREg. LOT: ~ COR~'. ~;~ <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION <br /> <br />COI,tTRA(YTOI:~,, <br />DA¥'J'.S,, WIL. L. IAM ~;. & REBECCA ~ .... <br /> <br />PHONE: 8 ~7'-'S.484 <br /> <br />47626 <br /> <br />WATER SUPF'LY: F'W <br />'rES]' HOLES READY: <br />SITE EVALUATION NUHBER: 45272 <br />EX]iSTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEF']'IC TANK PUMPED: <br />PREV]:OLJS NO,, BEDROOMS: <br /> <br /> ITEM QUANTITY AMOUNT <br /> STANDA~D ON-SITE SYSTEM 1 ¢'=='.~.,J. ,, <br /> <br /> TOTAL ASSESSE~ F'I~ES o~-" <br /> PREVIOUS RECEIPTS $255. <br /> TH~,S RECEIPT $~L .'~ <br /> <br /> 'BALANCE DOE $~,, <br /> <br /> F'AYEE: RECEIPT NO: <br /> t~E.l,,I,,;.J, ¢[:l) BY: C,L. .............................................................. TYPE: CHECK ~,: <br /> <br /> -,~'":';'~...... ATTACHED 9OCUME:NT FOR REQUTREffFNTS. .... OF ON-SITE SEWAGE; <br /> * THIS IS A VALID PERMIT $ THIS PERflIT EXPIRES 368 DAYS PEON ITS ISSUE DATE, IF <br />CONSTRUCTi[ON F'A];L~:~ TO HEET ALL ................ <br /> ,'Et~UI;*EH~NIS OF StArE LAWS AND NAR!ON COUNTY BUll. DiNG <br />ZON'.dqG O~D" Ah ;El, TNtS F'E~HIT SHALL ~E[,,ONE NULL AN~ VOID. <br /> <br />.~EHA dxo. S'i'7)/CUF4-f'AIN DRAIN <br /> <br />.O,)hAL. 5 1.-', W~ODi._EY, ~ ~,'.t~1 COUNTY <br /> <br />FORM # MC 15-56 REV, 4/90 OF FICE COPY <br /> <br /> <br />