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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: 888-5147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />The work will be performed by a registered builder, <br /> <br />!'5~v-h~'iDAT..-¢.~ '08Y0:[79~4~ flN~;' 'tAt'!;'56Y 59 ............... ~-'V%~ [bY~ ....... <br />.......... ~'~%EGE[_ ~. H~CY ........................................ ~ ..................... <br /> <br /> . '~ - , ~ OON?~AO? OI~Y; j UGh: ','SO~up~N~ LOAD'. <br />~ 7404 M:[I,..L .~,J,K RI) SE <br /> AU~,~VJ, L,I.,.iE OR 9752., ~A~I ~ :OUhTY ~ ] <br />~B;~E"b~"~O-FCdi~ No oF eEOROOMS <br /> <br />MAILING ADDRESS: <br /> <br />5~4 SW EASTHAN PARK WAY <br />6RESH~H,, OR 97080 <br />PHONE,~ <br /> <br />SU 8BIVISION: <br /> <br />SITE HUMBER." 94-82984 <br />YALUATION: <br /> <br />TYPE.' 0N-SITE SEWAGE <br /> <br />~ERM][T OR APPLICATION <br /> <br />~[h~TRAt. fOR~ FI% <br />S'[ EI'IGI,~,I,.,, MARY <br />5,54 Sg I~AS'THAN PARK WAY <br />~RESI'IAM~ OR ~TeBe <br />F I-IONE~ &bG-:/84e <br /> <br />9~56998 <br /> <br />WATER SUPPLY: PW <br />'tEST HOLES READY:: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: 1000 <br />EXISTING ;DRAIN FIELD LINES: <br />SEPTIC TANK PUMPEO: FORN <br />PREVIOUS NO. ~IED~OOMS: <br /> <br />t'EH <br /> SYSTEM EVAL. RF"T. <br /> <br />QUANTITY AHOtJN'f <br /> <br /> TOTAL ASSESSED FEES <br /> P~EV'I~US R~CEIPTS <br /> TNZS. RECEZFT <br /> <br /> BALANCE QUE ~. 00 <br />PAYEE~; STI{'NGEL, MARY RECEIPT NO: 57510 <br /> <br /> RECEIVE;O BY: JS ......................................................... TYF'I-': CK CNECK <br /> <br /> SI'~E ATTACHEI) I)OCIJ~IEN'f FOR REQUIRE:MEN'rS OF ON-SIrE SEWAGE BYBTE~. <br /> <br />THIS ~S ~OT A ~ERMIT. THIS ~APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />I-OLLOWING.HUST BE COHPL. ETE~. I1 IS THE RESPONSIBILITY OF' T4E APP.ICANT T( AS~ JRE TI-IhT <br /> HECESSARY INFORMATION HAS BEEN PROVIDE~. <br /> <br /> ......................... .................. <br /> <br /> ~-~ ~u ,~r~* ~ ~ .. ~F~- '. <br /> OFFICE COPY <br /> <br /> <br />