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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 - 4:80 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />of & registered builder, <br />The work will be performed by a registered builder. <br /> <br />¢ ~82~22 LF;V~;}RNAN RP SE ; CONTRACT CITY: ~ UGB: O00UPANT LOAD: <br /> AUMSV:(LI.,E OR 97¢~,. lAN,ON COUNTY ~ NO <br /> <br />~ At,JMSVDJ,,.E SITE NU~BE~: 94-~1692 <br /> PHONI:;,~ 749-:1,5~3 VAI,,.WATION~ <br /> <br />TYPE: OH-SITE ~qEWA~E <br /> <br />PER~IT OR APPLICATION HO: <br /> <br /> ,,IAYT3N o[I <br />4....I. ou S'FAYTONoL,O DR SE <br />SIAYI'ON~ <br />PHONE: 76Y..-23~2 <br /> <br />~854619 <br /> <br />WATER SUF'PLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NONBER: 81--S54 <br />EXISTING TANK SIZE: <br />EX:r, STIN5 DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> I T E' fi Q U A N T I T Y A Fi D '.,[ Il '¥ <br />STANDARD ON-SITE SYSTEM 1 <br /> <br /> TOTAL ASSESSED FEES $255,,~ <br /> PREVIOUS R;~CE;[ F'TS <br /> THiS RECEIPT $255.. <br /> <br /> DALANCE DUE $0. (.,3{~ <br /> FAYI .... I {~REM,-.N,. ,.U24/.,&,~i,I...~A IiE(.EI~; ,,[O ...... ~,._ <br /> <br /> .'¥::E ATI'ACNEQ DOC]JMEHT FOR RE(]U[REMEN'I'S OF ON-SITE SEWAGE SYSTEM. <br /> <br /> ~ THIS iS NOT A PERMIT. THIS ~APPLigATiOH HUST ~O THROUGH A REVIE~ PROgESS WHERE THE <br />I;OLJ..O~tNG HU&:I BE COMPLETED,, "I'~ I'S IHE 'EESPONSIBILITY OF THE APPLICANT TO ASS'JRE: THA-f' <br />A~,L NEOESSARY INFORMATION HAS BEEH PROVIDEB~ <br /> <br />OFFICE COPY <br /> <br /> <br />