|
MARION COUNTY'B'U,I.LDING INSPECTION
<br />SENATOR BLDG· NO. '~g5
<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 am performing work on a property I own or occupy.
<br />l am a registered builder OR ( ) the authorized representative
<br />of 8 registered builder.
<br />
<br />Other ,,
<br />
<br />PO BOX 8S9
<br />DSTRC,Uf' OR ~7342
<br />
<br />TYPE.' ON-SITE SEWAGE
<br />
<br />PERMIT OR APPLICATION
<br />
<br />WATER ,SUFSPLY: CW
<br />TEST HOLES READY:
<br />SITE EVALUATI'ON NUMBER:
<br />EX'iS'TING TANK SIZE=
<br />EXISTING DRAIN F:'IEL~ LINES:
<br />SEPTIC. TANK PUMPED:
<br />PREVIOUS NO., B~;D~OQMS: 2
<br />
<br /> ]:TF.M QUANTITY AMOUNT
<br />
<br /> TOTAL ASSESSI=~ F'~ES $~.,.,.,,~e
<br /> PREVIOUS RECEIPT~ $ 2,5,,5,,
<br />
<br /> BALANCE'DUE v
<br />
<br /> FAYEE, GIJWDERSON~ DWAYNE & JULIE INVOICE NO: 59887
<br /> RECE1VED BY: Cl.. TYPE: CE CHECK ,~:
<br />
<br /> -' ' ..... , ' -""
<br /> 51,,F: ATIALH[,D DOGUMId,ll FOR-- .[RENENTS OF, ON-BIlE 8E~A6E SYSTEM.
<br />
<br />CO~SI:~JET]ON F'A] S T) MEET ALL,~QQZREN~NTS OF S'TATE LAWS' A,D MA~ION COINTY B ~" D"hC
<br />ZONZJNG ORDINANCES, TNIS PERMIT SHALL D~:COME, NULL,, AND VOID,, ' .........
<br />
<br /> MA! .k ,: ':
<br /> S ~,, R.._¥,A£R.~ SEEPAGE TRENCHES,. FOR 2 BR NH: & 1 BR GUE'.,~T CAlvIN.
<br />~)OI,h~l,,l) E,, WOODLEY, ~'4A, l(IO,'! (.,9UN3't DLI):Li)~:NG OF,-,ZC..AL / 8Y
<br />
<br /> OFF]CE COPY
<br />FORM # MC t ~-56 REV.
<br />
<br />
<br />
|