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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET Nc= <br /> SALEM1 OREGON 97301 <br /> <br />PHONE: 588-5147 8:00 - 4:30 <br />HOUR CODE-A-PHONE: 588-7904 <br /> <br />I~tmaregisteredbuilderOR( ) the authorized representative <br />of a registered builder, <br />T'ne work wilt be ;~edormed by a registered builder, <br />Other <br /> <br />this document. <br /> <br />S GNATURE OF APPLICANT; <br /> <br />i_de~.~; DAlE 0~/~8Z'¢~, ~'I,ME. 1._..~d__.~& ............... tT~¥-£d¥1 1 CATEGORY; <br /> ItlLI_S~ KEVIN 98248-,,8~ ~ RESIDENTIAL <br /> <br /> lJ5 HOWE ST "' o ~EI'ROIT NO <br /> ~E FROIT OR ~7,~4,- ~ <br /> ..... <br /> <br /> HACKEY CREEK ADDITION <br /> <br /> SITE HUHBER: 94~88823 <br /> PH0NE: 854-3797 VALUATION: <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATIOH <br /> <br />CONTRACTOR, NO, 84745 <br />I(evin M Hills <br />PO Box <br />Dett"oit. 97342-0888 <br />PHONE: 854-3797 <br /> <br />9853176 <br /> <br />WATER SUPPLY: CW <br />TEST HOLE9 READY: YES <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTIN~ DRAIN FIELD LINES: <br />SEPTIC TANK PUMPEQ: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM <br />SITE EVALUATION, FIRST LOT <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br />BALANCE DUE <br /> <br />QUANTITY AMOUNT <br /> 1 $2G5.00 <br /> <br /> $0.00 <br />$265.00 <br /> <br />PAYEE: KeviD M Hills INVOICE NO: <br />RECEIVED BY: PM ....................................... TYPE: IN CHECK <br /> <br />SEE ATTACHED DOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br />NOTE: THIS DOES NOT GRANT OR IMPLY PERMISSION TO BUILD 'ON TNIS PARCEL~ PLANNING AND <br />ONSTRUCTION F'ER~ITS ~US1; 9E OBTAINED BEFORE BUILDING O~ SEPTIC INSTAI,,,LAT~ON BEGII'4S,, <br />,. R :Vi. EW., ,TY URI, DICTION, ,,Y ......... ATE ....................... <br /> <br />FOR~ # MC 15-~ R~V, 4¢80 OFFIiP. E COPY <br /> <br /> <br />