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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 HQUR CODE-A-PHONE: 588-7904 <br /> <br /> I)A'IE: 18/14/?,~ TIME: 9:16:28 <br /> HOLT, BOB <br />StTU~, ADDRESS <br /> <br />SIGNATURE OF APPLICA · ~ <br /> <br /> TAX LOT: CATEGORY <br /> 7572~298 RESIDE ,l'f I At. <br /> ' CONSTRUCTION TYPE DCCUPANCY <br /> <br /> 111~ WEST STAYTON RD SE ............. <br /> u svzL,.E oR <br /> <br />USE OF ~UILDING; <br /> <br />..... NO or BED~00M$ <br /> <br />SAME SITE 14UI4BEJ~: 93-83172 <br />PHONE: VALUATION: <br /> <br /> ~LOCK ' ~ECTt(~I~ ..... '~-,.. ..... ~N~I~ ................ R~h~ ..... ZONE <br /> <br /> 1:~ ~ '~ ~S '~'~, EFU <br /> · 'DEPTH ~.' ~ 'x~ ', ...... U~'I~ ....... ~-' 4RE~L0~; ......... OORNER: <br /> <br />17~ 246. 4~. ~ SF ,,~.,, ~0'u ~40 <br /> <br />MAP <br /> <br /> &2 <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERHIT OR APPL~CA~!.ON <br /> <br />?~5e667 <br /> <br />~WA~ER SUPPLY: PW. <br />"~;, ~'ES~,, HOLES READY. <br /> J'"S,.~.T'E EVALUATION NUMBER: <br /> E)~,STING TANK SIZE: <br /> EXISTIN(; DRAIN FIELd) LINES,'; <br /> <br /> - ' <br /> CONTRACTOR. NO. 3694 <br /> AAA SEPTIS SB~VICE SEPTIC TANK PUMPED: <br /> PO BOX 28811 '.'¢,,, PREVIOUS NO. BEDROOMS: <br /> SALEM, 973B7 .,. <br /> PHONE~ ~78-7454 .,~",:,~ ~. , <br /> · ~,,."%~ ................................................. <br /> <br /> REPA~ - MAJOR !~;.~ ,,; <br /> <br /> KKbVSUU~ ' <br /> THIS RECEIPT <br /> <br /> PAYEE: RECEIPT <br /> RECEIVED BY~ CL ............................ TYPE: CHECK ¢: 0 <br /> ........... .... ;~ ..................................................................... ~ ~ ~ <br /> <br /> SEE ATTACHEB QOCUHENT.EQR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. <br /> ~ THIS ~B MST A PER~IT. THIS APPLICAT~OH,HUST Cd] THROUGH A REVIEW PROCESS WHERE THE <br />F~LLOW~NG~NUST ~E COMPLETED. I'T IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORMATION HAS SEEN PROVIDED. <br /> <br />P~;i;:REVIEW: BY ........... DATE ............ CITY JURISDICTION~ BY DATE <br />~;i;!¢' ~ FILTER - PLANS'ATTACNE~ ..................................... <br />RE~RKS: SS/ MJR/RPR SA <br /> <br />OFF[CE COPY <br /> <br /> <br />