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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 />of a registered builder, <br /> <br />O~her <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document. <br /> <br />ISITUS AD~..[1..., I~RRY I CONSTRUCTION TYRE: o~M f I AL ~ <br /> 11633 DtTTER DR SE , ~ <br /> <br />MAILING ADDR~T-' ~ SUBDIVISION; <br /> .............. ........................................... <br /> <br /> PHONE: ~ VALUATION: : <br /> <br /> .......... ~ ~ <br />w DT~ : OE~t ~. ~' ............. ~ FX~ ~8 I}b~/~SS ................ i~ q h~m--'~T ~ . --~;c / '"~' -- ~ <br /> <br />TYPE: ON-BITE SEWAGE <br /> <br />PERMIT OR APPLICATION <br /> <br />CONT~ACTOR~ <br />O'NEIL~ HARRY <br /> <br />PHONE: <br /> <br />9G49~16 <br /> <br />WATER SUPPLY <br />TEST HOLES READY: NO <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELQ LINES: <br />9EPTI£: TANK PUMPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br />ITEM QLJANTITY AMOUNT <br />REPAIR - MAJOR ' : ' <br /> <br />$125.00 <br /> <br /> '. ~OTAL'A$SESSE.~ FEES <br /> · , jPREVIOUS RECEIPTS' $125.0050,00 <br /> · -',,,IH{SRECEIPT $125.00 <br /> BALANCE, DUE $0.00 <br /> PAYEE: O~NE~L. PARRY R~[.E],PT <br /> RECEIVED BY. CL ,~ ...... ,- - ..... <br /> ......................... ==:=:=~..= ....................... TYPE: 6K CHECK ~,, 10~ <br /> SEE ATTACHED ~OCUNENT FQ~' REQU~RE~ENTS,OF'ON-SI~E, SEWAGE 'SYSTEM. <br /> $ TNIS IS NOT A PERMIT. ¢'T~IS'APPLZCATION',NUST ~ THRQUCH A EE¥IEW PE8CESS W~EEE THE <br />FOL, LOWIN~ HUST BE COMPLETED.' 1T IS 'THE'" RESPQNS,IDILITY OF THE APPLICANT TO ASSURE THAT <br />ALI,_ NECESSARY INF'OR~ATION MAS BEEN PRO¥IBEQ. , ' ' <br /> <br /> PLAN REVIEW: DY ........ ~- DATE _ .... ~,- ............................................ <br /> REMARKS: RPR:MA,J TH:NO~ READY <br /> <br />FORM # MC 15-56 R~5/. 4/80 OFFICE COPY <br /> <br /> <br />