Laserfiche WebLink
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: ~88-7904 <br /> <br />SIGNATURE OF APPLICANT: <br /> <br />I am performing work on a property f ow~ or <br />I am a registered bvilder OR the authorized representative <br />of a reg~s[ered builder, <br />Tfle work will be performed by a registered builder. <br /> <br />Other <br />I have read and agree to the terms stated on the reverse side of <br />this documemt. <br /> <br /> SITE NUHBER: ?4-02685 <br />PNONE: VALOATION: <br /> <br />TYPE: OH-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION <br /> <br />CON'fRACTORA NO. ~301~ <br />ACE. SE. PTI6 <br />6220 LAKE LABISH ME <br />SAI,.EN~ 97~05 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: YES <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING BRAIN FIELD LINES: <br />SEPTIg TANK PUHPEB: <br />PREVIOUS NO. BEDROOHS: <br /> <br /> Il'EH QUANTITY AflOUHT <br />STAblDARD ON-SITE SYSTEM I $255.00 <br />SITE EVALUATION: FIRST LOT 1 $2~5,,00 <br /> <br /> TOTAL ASSESSED, FEES $528.00 <br /> BBE~IOUS RECEIPTS $0.00 <br /> THIS RECEIPT $520.00 <br /> BALANCE DOE $0., 00 <br /> PAYEE: ACE SEPTIg RECEIPT NO: 58~51 <br /> RECEIVED BY: P~ TYPE: CE gHECK ~: ~482 <br /> <br /> SEE ATTACHE~ QOCU~HT FOR REQUIREMENTB OF ON-~IT~ SEWAGE ~Y~T~. <br /> <br /> NOTE: THIS DDES NOT GRANT OR ~NPLY PERNISSION TO BUILD ON TRZS I AkCLL.:' *'= PLANNIN[; Al,II) <br />O, IoTRU[,[,[U~ PERHZTS HUS~ BE OBTAINED BEFORE ~UILDING OR SEPTIC INSTALLATION flEG~NS. <br /> <br /> RE~ARKS: SE - TH.READY ss:s'rD sYS <br /> <br />OFFICE COPY <br /> <br /> <br />