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MARION COUNTY BUILDING INSPECTION <br /> <br />SENATORBLDG, NO, 225 ~ i L <br />220 HIGH STREET NE <br />SALEM, OREGON 97301 <br /> SIGNATURE OF APPLICANT:.. ~ <br /> DATE: ............... <br /> <br /> PHONE: 588-5147 8;00 - 4:80 <br />24 HOUR CODE-A-PHONE: 588?904 <br /> <br />of a registered builder, <br />The work will be performed by a registered builder, <br /> <br /> .t072~) MAF:T:I:I,I LN NE ~ <br />AURORA OR 770e2 I, c'~[R~8~oI[?~UNTy} u~ ~OGOUPANT LOA~: <br /> <br />~I..OH~ OR ~78~7 S~TE NUMBER: ~ <br />PHONI[: &2S-CA87 VALU~TION: <br /> <br />TYPE: ON-SITE SEHACE WATEr( SUPPLY: F'W <br /> <br />PERHIT OR APPLICATION NO: <br /> <br />CONTRACTOR~ HI). <br />SM]:I'N~ ALAN <br />F'O BOX ~779 <br />ALOFIA OR, 970~7 <br />PHONE: &25-~487 <br /> <br />~0553&~ <br /> <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: 500~5 <br />E×I~TIN~ TANK <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREV]:OUS NO. BEDROOMS: <br /> <br /> ITEM QUANTITY AMOUNT <br />STANDARd) ON-SIIE SYSTEN i $~,.~,,¢,.80~"- <br /> <br /> TOTAL ASSESSED FEES $255., 00 <br /> PREVIOUS RECEIPTS <br /> THIS RECEIPT $25~i,, 00 <br /> <br /> BALANCE DUE $~),. 00 <br /> <br /> ........ ~ DOCUMENT FOR REQ{~REMEN ' - ITE SE ' <br /> * THIS IS NOT A ~ERHIT. · THIS,APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE <br />FOLI..DWIN~,H~ST ~E ?HPEETED. 'ET] ~S THE RESPONSibILITY 8F THE ~PP_I6~NT TB ~SSURE IN~T <br />~I_L NE6ES;~ARY ZNFORN~TZON HAB 9EEN PROV~ED. <br /> <br />PLAN RE:¥IEW: BY ............ '] ....... , ..... <br />RE:NARES= NEW SEPTIC <br /> <br />CITY JURtSBICT:rON: BY DATE <br /> <br /> <br />