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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 a registered builder OR the authorized representative <br />The work will be performed by a registered builder. <br /> <br />this document, <br /> <br />SIGNATURE Or APPLICANT: <br /> <br /> ADDRESS: ~ ~ONSTRUCTION TYPE: <br /> <br /> ..... : <br />~A~i~ X'D~b~; .................................................. 7 ~d~FG ~Tf~T ........................... <br /> <br /> COIqT~CT= 769-23~2 SITE NUHBER: 94-02157 <br /> PHONE: VALUATION: <br /> <br /> L ....................... ' L_ .o <br /> <br />TYPE: ON-SITE SEWAGE WATER SUPPLY: PW <br /> TEST HOLES READY: <br />PERHIT OR APPLICATION NO: 55441 SITE EVALUATION NUMBER: <br /> EXISTING TANK SIZE: 1500 <br />CONTRACTOR~ bi(). 34916 : EXISTING DRAIN FIELD LIMES: <br />STAYTON SEPTIC ?? <br />41155 STAYTON $CI0 DR ,~ : ' PREVIOUS NO. BEDROOMS: <br />STAYTON. <br />PHONE: 76~-2382 ~::'::;., <br /> <br /> PAYEE: ;~ <br /> RECEIVED DY: PB~_.. .... ~_i <br /> SEE AI'TACNED DOCUHENT ~O <br /> <br /> $ THIS IS A VALID PERHII <br />CONSTRUCTION FAILS TO <br />ZONING ORDIN~NC£S, <br /> <br />QUANTITY AHOUNT <br /> 1 $160.00 <br /> <br />$160.00 <br />$160.00 <br /> <br /> RECEIPT NO: <br />TYPE: CHECK ~: 0 <br /> <br /> ITS ISSUE DATE. IF <br />MARION COUNTY BUILDING AND <br /> <br /> &~-'~,-, 4. ~EW LO~-::L'.INE MUST Mt:rET TEN FEFT SETBACK <br /> FROH EXT. D/F LINES~ ::':' :., %,,::, ./?.¢¢ <br />I)ONAI,.D E. WOOQLEY~, HARION COUNTY BUILDING OFFICIAL / BY _ ................ ,~.,,~,,,,_ ................................ <br /> <br />OFF~CE COPY <br /> <br /> <br />