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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; $88-514,7 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE; 588-7904 <br /> <br />lamaregisteredbuifderOR( )theauthorlzedrepresentative <br /> <br />The work will be perform?d by e reSiStered builder. <br />Other_ <br /> <br />~L '~R'FC ~ ¢,~ ~RY 678~c~..-8~2 RE ;ZDENT] AL <br /> VAN bUY,;',,, CA 91~}6 , SITE NUMBER: 94-82199 <br /> <br />TYPE: OH-SITE SgWA~,E <br />PERMIT OR APPLICATION <br />CSN'['[~ACTOI~,~ N(]. 84745 <br /> <br />9~5789~ <br /> <br />WATER SUPPLY'-, C~¢ <br />TEST HOLES READY: <br />$]'TE EVALUATION NL;M~ER,',' '~552:_ <br />EXISTING TANK <br /> <br />SEPTIC ANK :~UMF'ED: <br />PREVIOUS NO,, BE~F(OOMS~ <br /> <br />.[1 ,..M 2UANTI 'fY Af4C,'UNT <br /> <br />fOTAL ,A~S[,SoED FEES <br />PR;~iVIOUS RECE~:PTS <br />THIS RECr_:t,i' T <br /> <br /> BALANCE DUb $8 ,. <br /> <br />RECE;[V~:[D BY; pM_; ........................................... I'YF"E: ~'t CHECK :~: <br /> <br />S[.E AI'I'DCHED DOCUMI:]NT FOR REQUIREMENTS OF ON-SI'rE SEWAOE SYSTEM. <br /> <br /> THIS IS ~OT A PERMIT. THIS APPLICATION HUST GO THROUGH A REVIEW PROCESS WHERE <br /> I'E,'.C{SSARY ZNFORMATTON HAS BEEN PRDVIDE~'. <br /> <br />OFFICE COPY <br /> <br /> <br />