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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 22,5 <br />220 HIGH STREET NE <br /> SALSM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />The work will be performed by a registered builder. <br />Other_ <br /> <br />I have read and agree to the terms sta~ed on the reverse side of <br />this document, <br /> <br />TYPE; ~N-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />C,I,)W[RACI'OR., NO. 7t, 16I <br /> <br /> ,.¢OX 524t <br /> <br />}>NONE,: <br /> <br />54487 <br /> <br />WATER SLIPPL. Y: PW <br />TEST HOLES READY;: YES <br />SITE EVALUATION NUNBER: <br />EXISTIN£; lANK SIZE:: <br />EXISTING DRAIN FIELD LiNF,':S~ <br />SF:F"f'IL; TANK PUMF'ED:~ <br />PREVIOUS NO. ~EDROOMS: <br /> <br />I 'l E; FI (] U A N T J; 'l' Y A N [;I U N T <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIF'TS <br />I'NIS RECEIPT <br /> <br />$265. <br />~,26t;. <br /> $0. <br /> <br />ALA ~ E DbE !1;8,, 00 <br /> <br />F-'AYEIi :: RECEIPT I'lO:: <br /> <br />R;7_CF_IVED BY." P~I ..................................... TYi ,2. CI,,'E']CK :IL", 0 <br /> <br />,=, .E A ~ J AC]'I[',I, DOCU]iE],J )" F'I.}R ',':~I~t;~[]'[RIE~tENTS OF ON-SITE SE:WA :~E .~, S T I..H,, <br /> <br /> '"'" NOT -' <br /> .1t I ,, '¥H;12:~})i.,..o ~nA ,I IR ,dq-J,.Y F'ERfi:£SS;i;ON 'fi.1 BUIL~ (]i*~ '[H,[.~ F'AR,r.:E:[ .... F'L.:q:,U,:i:!:NG AMD <br />( .... I,_.l, J .t t:'E'!;:?,;T!:; HJ:~ <br /> <br />J~. ,,~ ', ........ , S'!' ;-l'.)'f. 6 "~' ~' <br />FORM ~ MC 1~.S6 n~. 4~ OFFICE COPY <br /> <br /> <br />