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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 />} 8m performing work on a property I OWn or occupy, <br />I am a registered builder OR the authorized represen a ire <br /> o¢ a registered builder, <br />The work wild be performed by a registered builder. <br />Other____ <br />I have read and agree to the terms stated on the reverse slde of <br />~ni$ document. <br /> <br /> K.I;I_MAR'f :tN,, PAT 753~I38~ RESIDENTIAl_ <br /> <br /> ~U~SVZL. LE OR ~7~25 ~Ak~ON COUNTY NO <br />rU~E OF ~'Ul~i~': ~b OF BEDROOMS <br /> <br /> MAtUNG ADDRE~S: ' SUBDIVISION: <br /> <br /> ' SITE HUHBER: 94-~2&85 <br />i PHSMI~: ~ VAL[JAT~OM: <br /> <br />· ~ i <br />~WIDT~: ~DEPTH: I AREA: UNITS. IRREG. LOT'. ~N'~T .......... <br /> <br /> TYPE: OH-~TE SEttEE B~TER SUPPLY~ PW <br /> TEST HOLES RE~Y: YES <br /> PER~IT OR ~PPLICATION HO: 5~44~ S:~TE EVALUATION NUMBER: <br /> <br /> (,,OHrRA[,1OR~ HO. ~3Bi~ EXISTING ~RAZN FIEL~ LZNESt: <br /> ACE SEPTIC SEPTIC TANK PUHPEg: <br /> 6,,..,,B LAKE L~b],SH ME ~ PREVIOUS NO. ~E9ROOMS: <br /> SALEM, ~7S85 <br /> PI"IONE~ S93-;[~33 <br /> <br /> ITEt4 QUANTITY AMOUNT <br /> STAN~AR~ ON-SITE SYSTEM 1 <br /> SITE EVALUATION~ FIRST LOT i ~265~ <br /> <br /> TOTAL ASSESSED FEES <br /> P~EVIOUS 'RECEIF,T~ ~52~,, <br /> THIS RECEIPT <br /> <br /> ~ALANCE DUE <br /> <br /> PAYEE: RECEIF'T NO: <br /> RECEIVE~ BY: DM TYPE: CHECK ~: <br /> SEE 6f"r~f;14E~ DOCU~EN~ FOR REQUIREMENTS OF ON.-~TE ~E~GE SYSTEM. <br /> <br />NO/'E~ fltI,~ DOES 1,1~'7' K;RANT OR IMPLY PERMISSION TO BUILD ~N I'H]~S P~R(;EI,_. PLANNING Al,II; <br />ONSTRUCTIOi,I PI,i;I~M~:'i"S MUST BE; OBTAINED BEF'ORE BUILDING OR SEPTIC tNS'f'ALLATION BEGINS,, <br /> <br />R~i:MARKS?, ',;E .... SS:STD SYS. HARii£FAI. 0~ UPPERMOS" SURFACE. F'RE.,-~]TRUCT]8, STA(E'] '- <br />REC,OMHENDED, ACE SEF'TI? PHONE-~9;~-J. 837.,, ~ } <br />~)[)NAL~ E,. WOODI_EY, HARIOM COUrlTY BUII,,,QING OFFICIAL / BY _~ ~ <br /> <br /> <br />