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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 />) em a registered bullder OR ( the euthorized representative <br />Other <br /> <br />..... THOt AS L <br /> <br /> ,~3723 SCHULTZ RD <br />AURORA .... <br /> <br />18305 BROAB OAK BLVI) <br />ALOHA~ OR 97007 SITE NUtlBER= 9~-B1~28 <br />PHONE: '- ~') ~ <br />~BI-,~ VALUATION: <br /> ~ ~LOCK: F ~6~': ................... [ '~X~. <br /> ' OEPTN; ARE~2 ...... ~m~S .......... i'~~ L6T .......... ~'66~'~ ............ 1 <br /> : ............ 2..-5 .... ~C .............. ~0 ................~'--~0 <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR. NO. <br />YOUNG~ THOMAS L <br />18385 BROAD OAK BLVD <br />ALOHA~ QR ~70~7 <br />PHONE: 5~I-.5205 <br /> <br />9~4682B <br /> <br />WATER SUPPLY; PW <br />TEST HOLES ~EABY: <br />SITE EVALUATION NUNBER; 42251 <br />EXZST:[N~ TANK SIZE: <br />EXI~'r~NG BRAIN FIELD LINES: <br />~E~TIC TANK PUMPE~: <br />PRE~IO~S NO. BEI)ROOHS: <br /> <br /> I'['EM QUANTITY AHOUflT <br /> TILE DEWATERTH~ I $~t60., 08 <br /> <br /> TOTAL ASSESSEB FEES $360~ ~8 <br /> PR[VIOUS RECEIPTS $~. ~ <br /> THIS RECE~P~ $~6~. ~ <br /> BALANCE BUE $~ ~8 <br /> PAYEE: YOUNG, I'NOMA8 L RECE;[[~'.~ NO: 4986~ <br /> RECEIVEI) BY; PM TYPE',:~K CHECK ~; 8~5 <br /> SE~ ATTACHED DOCUMENT FO~ REQUIREMENT~ OF ON-~ITE SEQAGE ~YSTE~. <br /> <br />ALL IIECE~SARY INFORHATION HAS BEEN PROVIDED. <br /> <br /> PLA~ I,EVIk, W. BY_ DATE --~-.~ CXTY JUR~SI)ICTIO~: BY ~ATE <br /> RE~4ARKS: TD SYS <br /> <br /> <br />