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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 />of a registered builder. <br />I have read and agree to the terms stated on the reverse side of gATE: '-~ <br /> <br />DATE: e5/05/74 TI-ME: l~,.i~.O._ <br />6 -JI,GLI,EEI~ LORENZO <br /> <br />¢0~42:-.008 RES1DENi IAL <br /> <br /> ~i2~9~ ENLEN R[~ NE i~o~ blTY: O~i ~OOCUPANT LOAD: <br /> AURORA OR ~78~2 ~HARtON COUNTY ~ NO <br /> <br /> PHONE= : VALUATION: <br />......... 68. AC NO NO <br /> <br /> TYPE: OH-SITE SEWAGE WATER SUPPLY: PW <br /> TEST HOLES READY: <br /> PER~IT OR APPLICATIOH NO: 9854784 SITE EVALUATION NUMBER: 44212 <br /> EXISTING TANK SIZE: <br /> CONTRACTOR~ NO. EXISTING DRAIN FIELD LINES: <br /> GNIGLIERI~ LORENZO .4__ SEPTIC TANK PUMPED: <br /> ~¢ PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM ~ QUANTITY A~OUNT <br /> STANDARD ON-SITE SYSTEM 1 <br /> <br /> TOTAL ASSESSE~ FEES <br /> PREVIOUS RECEIPTS <br /> TNIS RECEIPT <br /> <br /> BALANCE' DUE <br /> PAYEE: GNIGLIERI~ LORENZO RECEIPT NO: 572~7 <br /> RECEIVED BY: PN TYPE: CK CHECK ~: <br /> SEE ATTACHE~ DOCOMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM, <br /> <br /> ~ THIS ~ ~OT A PERMIt. T~I8 ~LIOATION MUST ~ THE8~&H ~ REVIEW.PR~ESS WHERE THE <br />FOLLOWING HUST BE 6QMPLEI'ED, 'IT IS TNE EESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORHATION HAS BEEN PROVIBED. <br /> <br /> REMARKS; STD SYS <br /> <br />,OR~4 # ~C tO-~ REV,.~ OFFICE COPY <br /> <br /> <br />