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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 $:00 ~ 4:30 <br /> 24. HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am perform ng work on a roperfy Iown Of OCCdp¥, <br /> <br />PIL <br /> <br />SAME <br /> ! SITE NU?~BER: 94-00755 <br />PHONE: 749-1503 VALUATION: " <br /> ~OCK ]SECTION; TOWNSHIP: i SANGE, I ZONE. ~ M . ' <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />CAUGH~AN, ~LIZABETH <br /> <br />PHONE: 749~1503 <br /> <br />9053059 <br /> <br />WATER SUPPLY: PW <br />TEST ROBES READY: <br />SITE EVALUATION NUMBER; <br />EXISTING TANK SIZE: 750 <br />EXIS~INGDRA~N FIELD LIN~S: <br />SE?T~C T~NK PUMPED: 1/26/94 <br />P~EVIOUS NO. BEDROOMS: <br /> <br /> ITEM QUANTITY AMOUNT <br />ANNUAL EVAL. ~ TEMP OR HDSHP NH 1 $90.00 <br /> <br /> -- '"' TOTAL ~SSESS~D FEES S90.00 <br /> PREVIOU~ RECEIPTS $0.00 <br /> THIS ECEIVT $9o.oo <br /> <br /> S0.00 <br />PA~E: TERESA A ^F~R~M~(~ RECEIPT NO: 55521 <br />R,.~.,,:[VED BY: ~Bj~_~J F_% TYPE: CK CHECK #: 3168 <br /> <br /> ,.' ~.~ED DOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br />* THiS IS NOT A PER,IT. THIS APPLICATION ~$T 60 THROUGH A REVIEW PROCESS WHERE TEE <br />FOLLOWT','~, IsUST BE COMPLETED. IT IS TEE RESPO~SIBIuzTY OF THE APPLICANT TO ASSURE THAT <br />ALL M~CESSARY INPORMATION HAS BEEN PROVIDED. <br /> <br />FORM # MC 15.S6 RSV. 4/90 OFFICE COPY <br /> <br /> <br />