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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 />I am per(strains work on a Property I own or occ'upy. <br />I am a registered builder OR the authorized representative 81GNATURE OF APPLIGANT: <br />~f ~ ceglstered builder. <br />The work will be performed by a registered builder. <br />Other . <br />I have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br />11654 ~UNTING I..N <br />AURORA, OR 97002 SITE <br />PHONE: 678-2219 ; VALUAT:r. ON: <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERHIT Oi~ APPLICATION <br /> <br />COI'ITRAC10R~ NO,, <br />I',R I El, .._R, KEV.T. fl (BUYER) <br />t.1654 /¢(,tNTING LN <br />AURORA~ OR <br />PHONE: 678-2219 <br /> <br />9a56934 <br /> <br />WATER SUPPLY: PW <br />~ESI' HOLES READY: <br />S,rE EVALUATION NUMBER: 1~796 <br />EXISTING TANK SIZE: <br />EXISTING ORAZN F'IEI..~ L~NES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> I fEN QUANT I'fY AMSUNT <br /> SIAI4DARD ON-SITE SYSTEM ! $255,.~¢ <br /> <br /> '[ORAL ASSESSED FEES $255..00 <br /> PREVIOUS RECEIPTS $0.00 <br /> THIS RECEIPT $25~,,~0 <br /> <br /> BALANCE DUE $0..00 <br /> <br /> PAYEE: KR'[EGER, KE¥J:N (BUYER) RECEIPT NO~ ~744b:< "- <br /> RESEIVED BY: 6L ................................................... TYPE: CK CHECK 4i:= 876 <br /> <br /> SEE ATI'ACNEQ DOCUMEHT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEH. <br /> <br /> $ THIS I~ NOT A PE~IT. THI~ APPLICATION HUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE COMPLETED, IT IS THE RESPONSIBILITY OF 'THE APPLICANT TO ASSURE IHAT <br />ALL NECESSARY INFORMAl'ION HAS BEEN PROV~iDED. <br /> <br />REMARKS: ST;f) SYSTEM <br /> <br />OFFICE COPY <br /> <br /> <br />