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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: 888-7904 <br /> <br />i am a reoistered builder OR( ) the authorized redresentative <br />of a registered builder, <br /> <br />O~her <br /> <br /> i! CONTRACT CITY: ~ U'G~; i OCCUPANT LOAD; <br /> 82;Jl N SAHTIAfl HWY .... ' <br /> AU ~tS.V_ILLI:, OR_ _..~7~ NJ] <br /> '(~"~'I~iLDING: : NO OF BEDROOMS: <br /> <br />~ ~AME <br />~ SITE HUMBER: 94-83~78 <br />i PNOHE: 74~--2e79 VALUATION= <br />~Lbf: i'¢¢g ~ .............. =~E~F: E~ ~-8'~'; <br /> <br />~WDTH; DE~N: ~A; ~ U~; ~ ~G, LOT: I CORNER: <br /> <br />TYPE: O~-SITE 8EWA§E <br /> <br />PER~iT OR APPLICATION <br /> <br />CON-I'RACTOR~ biO. <br />BAKER~ CHARLES <br />SANE <br /> <br />PHONE: 74¢-20?? <br /> <br />57956 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: YES <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDEOON8: <br /> <br /> ITEM QUANTITY AMOUNT <br /> ALTERATION 1 $255.88 <br /> <br /> TOTAL ASSESSED FEES $255.00 <br /> PRE~IOU8 RECEIPTS $255.08 <br /> THIS RECEIPT $0.88 <br /> <br /> BALANCE DUE $8.00 <br /> <br /> PAYEE: RECEIPT NO: <br /> RECEIVED BY: cl .................................... TYPE: CHECK ~: 0 <br /> <br /> !~EE AI'TA~HED DOCUHENT POP REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br /> * TH~ IS A VALID PERHIT ~ THIS PERflIT EXPIRES 3&a DAYS FROM ~TS ISSUE DATE. IF <br />CONSTRUCTION PAILS TO MEET ALL REOU~REHENTS OF STATE LAWS AND MARION COUNTY BUILDING <br />ZONING ORDINANCES, THIS PERN)T SHALL BECOHE NULL AND VOID. <br /> <br />REMARI(S: AI,.,TERATION.i MARGINAl,. FOR S,T. ANDARD WiTH :CURTAIN DRAIN. ~IGH1',.,NE~D AN EFFLUf:_,'I',I'f' <br /> PUMP, MUST AI4ANDON ,E,,XISTING SEPTIC TANKS. RECEIPT & FORMS. (~l P <br />BONALD E WOOD EY, MARION COUNTY BUILDING OFFICIAL / BY ~ <br /> <br />OFFICE COPY <br /> <br /> <br />