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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 /> <br /> Other. <br /> I Dave read Add agree to the terms stated on the reverse side of pATE ...................... <br /> thl~ gocument, <br /> <br /> DAI't?~ 08tt6t94 TIHE.' .L~:~S~:~7 <br />6~i~ ~-~ .......................................................................... ~A~[Of; .............. ~T~OR~; <br /> <br /> 7927 STOIIE. FIELD GT / ~E ~b~+~-fi~¢v'- ...... T~-~: ............. ~'B~dO~AhT ~6~6: <br /> AUHSV].LLI/~ OR ~7~25 j~Ar~10N COONTY /NO [ <br />~O~"b?-~LOl~' ~NO O~ e6OROOMS <br /> I ................................. [ <br /> 7~? ~.~:~_~ ................................. <br /> <br />.................. :~"-~, ........... 7:r~7 .... ~;r" ..... :I~:;~ ............... ~"~:;:~ ................ ;':t~ ..... <br /> <br />TYPE: ON-SITE SEWAI;E WATER SUPPLY: F'W <br /> TEST HOLES READY: <br />PERMIT IDR APPLICATIOH NO: 5&7i& SITE EVALUATION NUMBEF,:: <br /> EXISTING T~NK SIZE.' 1200 <br />COMTRACTOR~ N0. EXISTING DRAIN FIELD LINES: <br />ALLEN,¢ K-r:iN & SANDY SEPTIC TANK ~UMPED: 8-~1 <br /> <br />PHONE: 74~-1860 <br /> <br />400 <br /> <br /> ITEM QUANTITY AMOUNT <br />EXISTING SYSTEM EVAL. !pF 1 $160.00 <br /> FEES $150.00 <br /> fD'~ $160.00 <br /> $0,,00 <br /> <br />PAYEE: <br />RECEIVED BY: DM 0 <br /> <br />SEE ATTACHED DOCIJM),':NT <br /> <br /> ~ THIS iS A VALII) <br />CONBTRUCTION FAILS TO MJ <br />ZONING ORDINANCES~ THIS <br /> <br /> RECEIPT NO: <br />~; TYPE: CHECK <br /> <br />: ~YSI'EH. <br />~ROM ITS ISSUE ]DATE. IF <br />AND MARION COUNTY BUILDING <br /> <br />RI'_'.NA RK S :: <br /> <br />I)ONALI) E,, <br /> <br />EXISTING <br />tc/O0,DLEY, ~AR IDN" COUt~i'~ BY ......................... ~ .................. <br /> <br /> OFFICE COPY <br /> <br /> <br />