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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 />[ am e registered builder OR ( ) the suthorized representative <br />of a registered builder. <br />The work will be performed by a registered builder.: <br />Other ,, <br /> <br />this document, <br /> <br /> A-./ <br /> <br />SIGNATURE OF APPLICANT, S' .... <br /> <br /> 1,1S40 ,JAHES WAY DR SE <br /> AUN!;.;V t LI,.F. OR 97.~25 <br />USE OF BUILDING; <br /> <br />-'~6~6¥ b'iYYi ~; } ~CtUPANT LOAD: <br />: NARION CO JNTY[ NO <br /> <br />CONTACT: 769-2302 I SITE NUNBER-' <br />PHONE: L VALUATION: <br /> <br />TYPE: ON-SITE SENACE WATER SUPPLY: PW <br /> TEST NBLES REA]DY: <br />PEI~HIT 01~ APPLICATION HO: ;9855443 SITE EVALUATION NUMBER: <br /> EXISTINC. TANK SIZE: <br />CONTRACTOE~ NO~ ~4~16 EX,STUN6 DRAIN FIELD LINES: <br />S'rAYTOI,i SEPTIC <br />~1155 STA~'r~N SCIO ]' 'PREVIOLIS NO. BEDROOMS: <br />STAYTON~ 9~8~ <br />PHONE: 76~-2~e2 <br /> <br /> ;¢ : ~'~""': ' ' ~ QUANTITY AMOUNT <br /> <br /> ITEM <br />SITE EVALUATION.~ EA. <br /> <br />PAYEE: SI'AYTON SEPTIC:!: <br />RECEiVE]D BY: <br /> <br />SEE ATTACHEi) ]DOCLIMEN1 <br /> <br />h: FEES <br /> <br /> TYPE: <br /> <br />RECEIPT NO.' <br /> CK <br /> <br /> $22%,08 <br /> <br /> $225.00 <br /> $`0,00 <br /> $,225.00 <br /> <br /> $0.00 <br /> <br /> 57911 <br />CHECK ~: 1487~ <br /> <br /> NOTE: THIS ]DOES NOT <br />ONSTRUCTIOH PERMITS <br /> PLAN REVIEW: BY <br /> <br /> REMARKS: SE: 2NJ)LOT-""?~RTi[T,IONIN6':i~ ~4,~ <br /> <br /> THIS PARCEL. PLANNING AND <br /> · *TIC INSTAL. LA'rION BEG:t:NS. <br /> <br />l-:y, ,, JLIR,I~ SB ]: C T I ON: I~¥ ........................ DATE ..................... <br /> <br />REV. 4~ OFFICE COPY <br /> <br /> <br />