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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: 568-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> lamaregioteredbuilderOR( )theauthorlzedrepresentative <br /> of a registered builder, <br /> The work will be performed by a registered buitder, <br /> Other <br /> <br /> DATE: 07/t9/94 TIME: 11:00:10 <br /> ROTH, ORVILLE ~ <br />[ StTU~ AODRESS: I <br /> <br />['O~E Of ~U(LDING: ;NO O~ <br /> <br />I ~ SMALL <br />~: 8S4 WQOQLAN9 DE " <br /> SILVERTOH~ OR ~7~81 SITE H~HBER: <br />~ PNONE: 87;~-4243 VALUATION: <br /> <br />iF;ESIDE ~.TIAL <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PER~IT OR APPLICATION <br /> <br />60NTRACTOR, NO. <br />ROI'H. ORVILLE <br />884 WOODLAND DR <br />~ILVERTON. OR ~7~81 <br />~RONE: 87~-424~ <br /> <br />56B87 <br /> <br />WATER SUPPLY: CW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTI6 TANK PUMPED: <br />PREVIOUS NO. ~EDROOMS: 2 <br /> <br /> ITEM QUANTITY AMOUNT <br />AUTHORIZATION NOTICE - FLD. ~ISIT 1 $1&0,.00 <br /> <br /> ,TOTAL ASSESSED FEES $160.00 <br /> ,PREVIOUS RECEIPTS $.1,60.00 <br /> THIS RECEIPT $0.00 <br /> <br />BALANCE DUE $0.00 <br /> <br /> PAYEE: INVOICE NO: <br /> RECEIVED BY:: DM .................................... TYPE: CHECK 8: <br /> <br /> SIZE ATTACHED DOCUMENT FOR REQOIREMENTS OF ON-SI'TE SEWAGE SYSTEM. <br /> <br /> * THIS IS A VALID PERHIT~I'THZS PERHIT EXP[R[$ 36g DAYS FROM ITS iSSUE DATE. <br />COI,IS'rRUCTIOI,I F~][I.~S TO MEET'ALL REQUIREMEHTS OF STATE LAWS AND MARION COUNTY BUILDING AND <br />ZONING ORDINANCES, THIS PE~I,T SHALL BECOME NULL AND VOID. <br /> <br />RIZNARKS: SS: AU W/VISIT t~.j ~ <br />DONALD E. WOODLEY~ MARION,COUNTY.BUILDING OFFICIAL / BY ........................................................ ~...._ <br /> <br /> OFFICE COPY <br /> <br />FORM # MO 1 G.56 REV. 4/90 <br /> <br /> <br />