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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 />Other_ <br /> <br />CLARK, STAN 61288-000 ~ RESIDE~TIA~ <br /> AUMSVILhE OR 97325 ~MARZON COUNTY [ NO <br /> <br /> SITE NUHBER: 94-00648 <br /> PHONE: VALUAT ION: <br /> <br />LOT'. <br /> I , | EFU 60 : <br /> , 4 98 1W _ <br />¢,'~P~ -- d~ ~E~ u-~7- ....... , ~ i:5~: .... ~b~ ........... <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERNIT OR APPLICATION NO: 52887 <br /> <br />CONTRACTOR, NO. 34916 <br /> STAYTON SEPTIC <br />41155 STAYTON SCIO DR SE <br />STAYTON, 97383 <br />PHONE: 769-2302 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUNPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br />ITEM QUANTITY AMOUNT <br />REPAIR - MAJOR 1 $125.00 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$125.00 <br />$125.00 <br /> $o.0o <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: RECEIPT NO: <br />RECEIVED BY: PB TYPE: CHECK #: 0 <br /> <br />SEE ATTACHED DOCUNEHT FOR REQUIRENENTS OF ON-SITESE~AGE ~YSTEM. <br /> <br />~ THIS IS A YALID PER, HIT'* THIS PENXIT EXPIRES 360 DAYS FKOH ITS I85U~ DATE. IF ',' <br />CONSTRUCTION FAILS TO MEET ALL REQUIREMENTS OF STATE. LAWS AND MARION COUNTY BUILDING AND <br />ZONING ORDINANCES, THIS PERMIT SHALL BECOME NULL AND VOID. <br /> <br />REMARKS: MAJOR REPAIR. MUST VERIFY PROPERTY LINES PRIOR TO CONSTRUC~O~ <br />DONALD E. WOODLEY, MARION COUNTY BUILDING OFFICIAL / BY <br /> <br />FORM # MC 15-56 REV. 4/90 <br /> <br />OFFICE COPY <br /> <br /> <br />