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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 />Other. <br /> <br />'D~¥1'I.;: 06/24/94 TIHE; 1.,,~.:02 <br /> ....... TAX LOT: <br /> <br /> ~IGL~ NtLL, CREEK RD SE <br /> ~tJMSVILLE O~ 77~25 <br /> <br />IL4, <br /> <br />', ~E§%~N'r z At... <br /> <br />...................CONSTRUCTION TYPE OCCUPANCY; <br /> <br />j'CtC~f'~l~NTy ' N~,~e; ..... ¢~OCCU~^kt LOAD' <br /> <br />OSg OF BUILD]~.:. <br /> <br />SUBDIVISION: <br /> <br />PHOFIE;: 749-'2207 <br /> <br />SITE <br />VALUATION: <br /> <br /> ' BLOCB' BECTI(~N ................ ~bWNSHIP: .... RA~E ..... ' ZONE; MAP. <br /> 26 8S 2W . AR 51 <br />WIDTH; ..... ~'E~T'I~': ...... ARE,~ uNrrs: ~, LOT CC~OE R'. <br /> <br />TYPE: OH-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION <br /> <br />[iON'FRACTOR~ biO. <br />FF'I..U{;~ NIKE & NANCY <br /> <br />90~5882 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: 5-94 <br />PRE¥IOUS NO. BEDROOMS: 2 <br /> <br />PHONE,~ 749.-2207 <br /> <br />ITEM QUAN'FITY AMO~JNT <br />REPAIR - M'.[NOR I $8% 08 <br />AOTHORIZATION NOIICF -- NO VI,,ZT :[ $95.8¢ <br /> <br />TOTAl.. ASoEBSED FEES <br />PRI:'V tOUS RECEIPTS <br />THIS RECEIPT <br /> <br />BALANCE DUE $28.00 <br /> <br /> PAYEE: RECEIPT NO: <br /> R.'TCF:/VED BY: c],. ........................................................ TYPE: CHECK ~,: ~ <br /> <br /> SEE ATTACNED DOCUHENT F~ ~EQUIR~HENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br /> * THiS IS NOT A PERHIT. THIS APPLICATIOH ~UST 60 THROUGH A REVIEW PEOCESS WHERE THE <br />FOLLOWlhH~ ~UST BE CO~PLEI'Eg. IT IS THE ~ESPONSIBILITY OF THE APPLICANT TO A, ~ iRE THAT <br />Al, I, N[.L[~SAkY ~NFORflATION HAS BEEN PROVIDED, <br /> <br />F(FNhI~KS'.: S, ,,AU ~i:FNOR TJqi, ll~ REI-"LA[;EHEqT <br /> <br />Ct'fY JURISDI:C'I]:ON: gy DATE <br /> <br />OFFICE COPY <br /> <br /> <br />