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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 />I have read and agree to the terme stated on the reveree side of <br />thJ8 document. <br /> <br /> i CONSTRUCT ON TYPE'. ; OCCUPANCY: <br /> : I <br /> i CONTRACT C TY'. ! UGB , OCCUPANT LOAD: <br /> 7404 MILL CREEK RD SE <br />AUMSVILLE OR 97;~25 MARION COUNTY NO , <br /> <br /> ~W EASTMAN PARK WAY <br /> <br />PHONE~ 666~184~ VALUAT~ON~ <br /> <br />TYPE= OH-SITE SEHAGE <br /> <br />PERHiT OR AI:~PLICATIOH <br /> <br />CONTRACTOR~ NO, <br />$~ENCEL. MARY <br />5,¢4 SW EASTMAN PARK WAY <br />GRESHAM. OR 97888 <br />PHONE: &&6-1840 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER= <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: FORM <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM QUANTITY AMOUNT <br />EXISTING SYSTEM EVAL. RPT, 1 $168~00 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS' RECEIPTS <br />THIS RECEIPT <br /> <br />~ALANCE DUE <br /> <br />$168.00 <br />$160.00 <br /> $8.00 <br /> <br />$0.00 <br /> <br /> PAYEE: RECEIPT NO: <br /> RECEIVED BY: CL .................................. TYPE: CHESK #: 0 <br /> SEE ATTACHED DOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br /> * THIS IS A VALID PERHiT $ THIS PERHIT EXPIRF~360' DAYS FROH ITS ISSUE DATE. IF <br />CONSTRUCTION FAILS TO MEET ALL REQUIREMENTS OF STATE LAWS AND MARION COUNTY BUILDIN~ AMI) <br />ZONING ORDIHANCES~ THIS PERMIT SHALL DECSME NULL AND VOID. <br /> <br />REMARKS: ESE: PARTITION-L/L ADJ. NEW LOT LINES flU¢T MEET 10 FEET SEPARATION FROM EXISTING <br /> D/F LINES AND ALLOW SPACE FOR COMPLETED/F REPAIR AREA LLA 94-10 <br />DONALD E. WOODLEY,~ MARION COUNTY BUILDING OFFICIAL / BY <br /> <br />OFFfCE COPY <br /> <br /> <br />