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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 />I have read and agree to the terms 8tared on the reverse side of <br /> <br /> SAME <br /> SITE, HUHBER: 94-8396Y <br /> PHONE: 74?-3345 VALUATION: <br /> <br />........................ "~ --- ~r---~--¢¢'' ........ NO ....... ~ ............................... <br /> <br />TYPE= ON-SITE SEMAGE <br /> <br />PERHIT OR APPLICATION <br /> <br />CONTRACTOR~ NOn 34916 <br /> STAYTON SEPTIC <br />411~5 81'AYTON 8CIO ~R <br />8TAyTON. 975~3 <br />PHONE: 769-2302 <br /> <br /> ITEM <br />REPAIR -MAJOR <br /> <br /> PAYEE: <br /> RECEIVED DY: CL <br /> <br /> SEE ATTACHED DOCUMENT <br /> <br /> ~ THIS IS A VALID <br />CONSTRUCTION FAILS TO <br />ZOHIMG ORDINAHCES~ THIS <br /> <br /> WATER SUPPLY: PW <br /> TEST HOLES READY: YES <br />HO: E4~S26 SITE EVALUATION NUMBER: <br /> EXISTING TANK SIZE: <br /> EXISTING =~RAIN FIELI) LINES: <br />~,.'~-',' '",~:':'~t,"3EP~ 'T:AHK'PUM~E~: <br />SE PREVIOUS, NO. BE~'ROOMS: <br /> <br />AMOUNT <br /> $125.00 <br /> <br />::'~ $1 ,. ¢ ,, 00 <br /> ~:" $125.88 <br /> $0 00 <br /> <br /> :: REC.EIPT NO: <br /> : TYPE. CHECK ~." 0 <br /> $~STEM. <br /> }FI~oM ITS IgSUE ~ATE. If <br /> <br />REMARK,>,. SS. MAJ. COMBI~E~ LO~S:~ OKA:~ FOR:'STAN/)~Ri):~. AN'::EFFLUENT BUMP MIGHT BE MECESSARY. <br /> <br />FORM # MC I S-SS R~V. 4/80 0 F FICE COPY <br /> <br /> <br />