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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: S88-5147 8:00 - 4:80 <br />HOUR CODE-A-PHONE: 588-7904 <br /> <br />DATE: OB/O?/?Z~ TIME: <br />bOYCE, Tr~ <br /> <br /> 14747 ALBERS WAY NE ~ / <br /> AURORA OR ~7~2 <br /> <br /> , 85~5 oW oEMINOLE RD ~ <br /> [ PHONE~ 644-53~',~ <br /> ~ VALUATION: ! <br /> <br /> ~i5~: 5E~i (~--' '-~ ~ [ ~2%--~ %-[~'~5f~ ............ FOb~% ................................ <br />........ - ¢ ................... 2 <br /> <br />PERHIT OR APPLICATION NO: <br /> <br />?NTRACTOR, NO. <br />BOYCE, ~IM <br />85~5 SW SEMIHOLE RD <br />~UAI_ATINv OR 97062 <br />FHONE: 6~4-53~3 <br /> <br />9~48968 <br /> <br />'TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRA%N FIELD LINES: <br />SEPTIC TANK PUMF'ED: <br />PREVIOUS NOu BEDROOMS: <br /> <br /> ITEM <br />STANDARD ON-SITE SYSTEM <br /> <br />PAYEE: <br /> <br />TOTAL ASSESSE~ FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QLJANTITY AMOUNT <br /> $8.88 <br /> <br />$0.00 <br />$0.~0 <br />$0.00 <br /> <br />.'BALANCE DU~ $0.00 <br /> <br />RLCEIVED BY: gL .......................................... TYPE: CHEEK ¢: 0 <br /> <br />SEE ATTACHED DOCUMENT PDR REQUIREMENTS OP ON-SITE' SEWAGE SYSTEM. <br /> <br />THIS IS NOT A PER~iT. THIS I~ A FORFEIT DOCUHENT. <br /> <br />REMARKS: FORFEIT OF UNISSUED' APPLiI:CATION ~0436~1 <br /> <br />~O,M # MC ~-~ ~e,,..~/~o OFFICE COPY <br /> <br /> <br />