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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 /> The work wilt be performed by a registered builder. <br /> Other. <br /> <br /> , OWNE~¢',]' f,.,, ,1,,, ?. ?? ~ 4 'f']:HE,', 8'r 5L~';-42 ' ~A~ Ldf'. <br /> <br /> ' .tALLAC.;,~, ~ I,NN,.~I I:(ESIDENTtAL <br /> <br /> ALJHSVIL. I_.E OR ?7325 HARZ0N COUNTY <br /> , <br /> <br /> SAHE <br /> ~ SITE NU~BE~: 94-84515 <br /> PHONE: <br /> 749-2~4:~ <br /> ~ VALUATIOM: <br /> j~bT: ~ 8LOCK. } ~ECT~ON: TOWN~NIP: RANGE: i ZONEr , MAP; <br />............. ' :,,?, ~-...:-~ ~0 <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION <br /> <br />CONTRACTOR, N0. <br />UALI-ACE~ MIdt'IET <br /> <br />PNONE~ 749-2643 <br /> <br />WATER SUPPLY <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: 5-~1-89 <br />PREVIOUS NO,, BE~I~OOMS: <br /> <br /> t TEi"I QUANTITY AMOUNT <br /> AI,IhlUAL I:Z'VAL,. - TEMP OR FIOSHP i'4H I <br /> <br /> TOTAL A~SESSED FEES $~0,,00 <br /> PRE~ tOUS' RECEIPTS ' ~90.. <br /> THIS RECEIPT ~0,, 00 <br /> <br /> BALANCE I)UE ~0,, 00 <br /> P'c~YEE ~ RECEIPT NO: <br /> RE[;I?IVE]) ]BY,~ cl TYPE: CHECK i 0 <br /> ¢lt:.].;, A'ITACNED DOCUMENT FOR REI;~UZREMENTS OF ON-SITE SEWAE. E SYSTEM. <br /> <br /> THIS IS A VALt]) PERMI,T ~ THIO PERMIT EXPIRES 368 DAYS FROM ITS ISSUE DATE. IF <br />Ct.INSFRUC'I'J;ON FAILS '[-&l ?'ET A L REQU~',REMENTS OF STATE LAWS AND MARION CO NTY '~U]' <br />ZONINI; ORDII,IANCES,~ THIS PER~IT SHALE BECOME NULL AND VOID. '~ ............... <br /> <br /> F;~f'::MC/RK.S:: r'~s= hd?~p reneuai-- PF. ].2 21 24 O~aY TO CONTINUE <br /> HDSF' CON -"T REVZE~A[;A' ~ TWO <br /> YEARS ,, <br /> <br /> OFFICE COPY <br /> <br /> <br />