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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 />WARD~ H. BERNADINE ] /[ <br /> AURORA OR 970B2 !MARION 60UNTY~NO <br /> <br /> SAME <br /> PHONE: 671;,--2656 /VALUATION: <br /> / <br /> <br /> / <br /> <br /> / TEST HOLES READY: , <br />PER~IT ~ APPLICATION NO: 5~5 SITE EVALUATION NUMBER: <br /> / EXISTING TANK SIZE: <br />CONTRACTOR,. HO. ~ EXISTiHG ~RAZN FIELD <br /> SEPTIC TANK PU~PED= <br />WARD~ fl. BERNADINE <br />SANE PREVIOOS NO. BEDROOHS: <br /> / <br />PHOME: 678-265~ / <br /> <br /> ITEM <br />ANNUAL EVA[,. - TEMP OR ~SHP MH <br /> / TOTAL ASSESSE~ FEES <br /> PREVIOOS RECEIPTS <br /> 'TB l~ EECEIPT <br /> <br /> RECEIVED <br /> <br /> SEE' A'IT,4CI, IiZ 0 <br /> <br />* THIS IS <br />ONSTRUCTiO <br />ZOMING OR D'.[ <br /> <br />$90.00 <br /> <br />$9~,,00 <br /> $0.00 <br />$90..00 <br /> <br /> ~ALANCE'DUE $0.00 <br /> ~ 'P~ ~ RECEIPT NO: ~5727 <br /> TYPE: ~ CHECK 8: 0 <br /> <br /> FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br /> PERN[T~ THIS'~ERHXT'/XP~EES'~&~' DA~S FRON ITS I~SUE DATE. IF <br />TO M~ET AIL. REQUIREMENTS OF STATE,LAWS AID MARLO* ,}J,'fY BJI~_D:[N6 ANg <br />TI'tlS PERMIT SHALL ~ECOME'NULL AN~ ~OID. <br /> <br /> gk".~Rh..: SE. PERATE SEPTIC' SYSTEH- REFUI,!D APPL,. <br />/ONALD E, WQODI._EY, NAR!ON COUNTY ~UILi)IMG OPF'ICI~L / BY .................................................................................... <br /> <br />~ORM # MC 15-5,6 REV, ~ OF FICE COPY <br /> <br /> <br />