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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: 558-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />¢ e registered builder. <br />The work wilt be Oedormed by 8 registered builder. <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document, <br /> <br />, 776e 75TH PL SE ~"~'~j~Y: ~OO~ ;OCCUPANT LOAO: <br />' ~" ' ~ MARION COUNTY ~ NO <br /> AUH,~VILLE oR ~7~B1 <br /> <br /> ................................................................ .................... <br /> <br /> 77e8 75TH PL SE , <br /> SALEM~ OREGON 973~1 ~ SITE ~U~BE~: ~4-~4177 <br /> PHONE: 74¢-3811 ~ ~ALUATIQN: <br /> <br />, ~ 3. o ~ AC , NO I NO <br /> <br />TYPE: ON-SITE SEBAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR° NO. 36949 <br /> AAA SEPTIC SERVICE <br />PO BOX 28811 <br />SALEM~ 97~07 <br />PHONE: 378-?454 <br /> <br /> WATER SUPPLY: PW <br /> 'rEST HUt. ES READY= <br /> SITE EVALUATION HUMBER: 44866 <br /> EXISTING TANK SIZE: <br /> EXISTING DRAIN FILL9 [,,INE8~ <br /> SEPTIC TANK PUMPE~: <br />PRE¥'IO0$ NO. BEdROOmS: <br /> <br /> ITEM QUANTITY AMOUNT <br />SAND FILTER I $455.00 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />TNIS RECEIPT <br /> <br />$45o.00 <br />$455-00 <br /> $0,,00 <br /> <br /> BALANCE DUE $0.00 <br /> <br /> PAYEE: RECEIPT <br /> RECEIVED BY: cl ....................................... TYPE: CHECK ~: 0 <br /> <br /> SEE ATTACHED ~OCUMENTFOR REUUIREMEN'rSOF, ON-SITE SEWAGE SYSTEM. <br /> <br /> ~ THiO I8 A VALID PERMIT ~ THIS PERMIT EXPIRES ~&B SAYS FROM ITS ISSUE ~ATE. IF <br />CONSTRUCTION FALLS TO MEET ALL REQUIREMENTS OF STATE LAW~ ~ND MARION COUNTY BUILDIN~ <br />ZONIHG URDINANCES~ THIS PERMIT SHALL BECOME hiULL AND VOID, <br /> <br />REf~ARKS: SANg FILTER <br /> <br />~)ONALD E. WOODI_EY,~ MARION COUNTY BUTLI)ING OF'F~CiAL / BY <br /> <br />COPY <br /> <br /> <br />