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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 />I am a registered builder OR ( ) the authorized representative <br />Other ................. <br /> <br /> RFLU~ M~E. &. ~A~CY Ls782~e~B RESIDENTIAL <br /> SITUS ADDRESS: , CONSTRUCTION TYPE; ~ OCCUPANCY: <br /> <br /> 8167 MILl. CREEK RD SE <br /> AJHSVI[LE OR V7~25 MARION COUNTY NO <br /> <br /> ; ~ITE HUMBER: ~4-82~85 <br /> PHONE: 749-2287 ~ VALUATION~ <br />~L'8~; ~ 8~OCK ~ SEC~ ON ' TOWNSRIP: ~AN~E; ~ ZON~; MAP: <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERHIT OR APPLICATIUR <br /> <br />CONTRACTOR. <br />PFLUG~ HIK~ & NANCY <br /> <br />PHONE: <br /> <br />55882 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTIHG DRAIN PIELD LINES: <br />SEPTIC 'TANK PUMPED: 5-94 <br />PREVIOUS NO. BEDROOMS: 2 <br /> <br /> ITEM <br />REPAIR - MINOR <br />AUTHORIZATION NOTICE -,NO VISIT <br /> <br />QUAN'fITY AMOOHT <br />1 $85.00 <br />1 $95.08 <br /> <br /> TOTAl,. ASS~SSEQ~FEES $180.00 <br /> PREVIOUS RECEIFTS $180.80 <br /> THiS RECEIPT $20,,00 <br /> <br /> BALANCE DUE ~0,,00 <br /> <br /> PAYEE: RECEIPT NO: 59112 <br /> RECEIVED BY: PM ............... ~.~ ....................... TYPE: CHECK 8: 0 <br /> <br /> SEE ATTACHED DOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br /> $ THI~ IS A VALID PERHIT ~, T~IS ~ERMIT EXPIRES ~&O BAYS FROM ITS ISSUE ~ATE. IF <br />CO~STRUC'rION FAILS TO MEET ALL EEQU~REflEHTS OF STATE LAWS AhD MARION CO]~TY BUILDING AN~ <br />ZOHIMG OR~INANCE8~ THIS PERMIT SHALL BECOME NULL ANB VOI~ <br /> <br />REHARKS: SS;AU MINOR TANK REPLACEMENT <br /> <br />])ONALD E. WOOI)I. EY, ~A¢'?.IOH'COON]'Y'BUILDING OFFTCTAL Z BY .................................................................... <br /> <br /> OFFICE COPY <br />FORM # MC 1~.56 REV. 4/90 <br /> <br /> <br />