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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97'301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />[ am performing work o¢~ a property I own or occupy, <br />I am a registered builder OFf the authorized represen a ire <br />of a registered builder, <br />The work will be performed by a registered builder, <br />Other <br /> <br />this document. <br /> <br /> ~002, ,W~YNE L <br /> ;SITUS ADDRESS; ' CONSTRUCTION TYPE; , OCCUPANCY; <br /> <br /> 7~1S STONEEJ;ELD CT SE · <br /> AUHSVII,,I_[~ OR 97325 ~MAF(ION COUMTY <br /> <br /> ........ [ SITE NUHBER: <br />~: I:q"IONE~ 749"'2234 j VALOAT]:ON~: <br /> <br />TYPE: OH-SITE SEWAGE <br /> <br />PEEHIT OR APPLICATION <br /> <br />COH fRACI'OR. <br />klOOD~ W(.YNE' L <br />SA~4E <br /> <br />PHONE: <br /> <br />WATER ~UPPL. Y: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EX]'SI'ING TANK SIZE: 100~ <br />~XI~I'IM6 DRAIN FIELD <br />SEPTIC 'rANK PUMPED: <br />PREVIOOS NO. BEDROOMS: <br /> <br /> OUANTITY AMOUNT <br />,::×I,.~TIH6 SYSTEH EVA£.. RPT., ;, ~.[~ ~ . 00 <br /> <br /> TOTAl,. ASSESSED FEES <br /> PREVIOUS RECEIPTS ¢~). 0(8 <br /> . $8.00 <br /> ;.;~ ,, .~THIS R~[:EZPT, DuE <br /> <br />S[~E A'FfACI.fl,::9 DOCUNEM'F For< R',E[}UIREHIEH'[S OF ON-SITE SEWAGE <br /> <br /> THIS IS I,IOT A PE~IT. :THIS APPLICATIOH ~OS~ 60 THROU6H A REVIEW PROCESS WHERE THE <br /> <br />I:I..AN I:'~:VZEW:: BY ...................... DATE_ ........................... CITY JUR-I:SI)ti:CTION~ <br /> ¢iN~O APPI_:i'[;,4TtON FOR <br /> <br />!~4 Y I) A 'r E.: <br /> <br />NEI,_,.Do /-bSB£)R H,'::)F ,¢ !:"F: <br /> <br />FORm # MC 15-56 REV. ~mO OFFICE COPY <br /> <br /> <br />