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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 em performing work on a property I own or occupy. <br />] am a registered builder OR ) the authorized representative <br />Ct a registered builder, <br />The work wll~ be performed by a registered builder. <br />Other. <br /> <br />WALLACE, ROBERT & VALARIE 73500-220 RESIDENTIAL <br /> AU~SVILLE OR 97325 iMARION COUNTY i NO <br /> <br /> SA~E <br /> SITE NUMBER: 94-00725 <br /> PHONE: 769-3252 VALUATION: <br /> <br /> _ 19. ..... 9, S <br /> 0.6~ AC I YES YES <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERNIT OR APPLICATION NO: 9053010 <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: 500 <br />EXISTING DRAIN FIELD LINES; <br />SEPTIC TANK PUMPED: 2/15/94 <br />PREVIOUS NO; BEDROO~S: 2 <br /> <br />2O0 <br /> <br />ITEN QUANTITY A~OUNT <br />~EPAIR - MINOR 1 $g5.00 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$85.00 <br /> $o.0o <br />$85.00 <br /> <br />BALANCE DUE S0.00 <br /> <br />PAYEE: ,ROBERT & ~R~NALLACE RECEIPT NO: 55470 <br /> ............................. <br />SZE ATTACHEO DOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTE~. <br /> <br />* THIS IS NOT A PERNIT. THIS APPLICATION h'UST 60 THROUGH A REVIEN PROCESS W[ERE <br />FOLLOWING MUST BE COMPLETED. IT IS T~E RESPONSIBILITY OF THE APPLICANT TO ASSURE <br />ALL NECESSARY INFORMATION EASBEEN PROVIDED. <br /> <br />Fo~ ~, MC ~ ~-~ Re,', ,~ OFFICE COPY <br /> <br /> <br />