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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. NO. 225 <br /> 220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> PHONE: 588-5147 8:00 - 4:30 FiLE <br /> 24 HOUR CODE-A-PHONE: 588-7904 ~/~.-----~---~.~% ~.~ <br />I am performing work on a property I own or occupy, <br />I am a registered builder OR the authorized representative SIGNATURE OF APPLICANT <br />of ~ registered builder, <br />The work will be performed by ~ registered builder, <br />Other <br />I have read end ~gree to the terms steted on the;reverse side of DATE; <br />this document. <br /> <br />JAMES & MONICA ~ RESIDEN'rIAL <br />.............................................. ......................... a-&'~% + ~'b'& ~- ~ ~'h- +"~r~'[; ............................... ~dt0fiAN'~y.~ ' <br /> <br /> ..... OR 97325 " HARIOfl COUNTY NO J <br /> <br /> AUHSVTLLE <br /> 'U'(JqKG'F~? .......................................................................................................................... %6"~F <br /> ,. <br /> CONTACT: 7~9-23e2 SITE NUHBER: 94-~2158 <br /> PHONE: ~ ~ VALUATION: <br /> <br />........................ ...................... ................... [ ............... <br /> <br />TYPE:'OH-SITE SE~A~E <br />PERH~T OR APPLICATION HO: ?~55442 <br /> <br />CoN'rRACTOR~ NO. 34916 '' T "' . <br /> STAYTON SEPTIC SEPTI.C ANK ~UMPED. <br /> <br />PHONE: 769-2502 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: YES <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br /> <br /> ITEM QUAHTITY AMOUNT <br />SITE EVALUATION, FIRST 1 $265.00 <br /> <br />$265.00 <br /> $0.00 <br />$~6~,, 00 <br /> <br /> $0.00 <br />PAYEE: SI'AYTON SEPTI[ RECEIPT NO: 57910 <br />RECEIVE~ BY: PM TYPE: CK CHECK ~: 14878 <br /> <br />SEE ATTACHED BOCUNEN1 E SYSTEM. <br /> <br />NOTE,~ THIS DOES NOT 0~ THIS PARCEL. PLANNINr, AND <br /> <br />PLAN <br /> REVIEW: <br /> BY <br /> <br />REMARKS: SE: i~l' LOT <br /> . <br /> <br />FORM # MC lS-~ REV, 4/~0 OFFICE COPY <br /> <br /> <br />