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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 - 4:90 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />of a registered builder, ~..._~E <br />have read ~nd agree' to the terms stated on The ~everse side of <br /> <br />I)Ak~% ,JOHN RESIDEN'FIA_ <br /> <br /> 118~4 VICKI LANE ~E L .......................... <br /> AUMoViL, L,E OR z CT, ' ~ GB; OCCUPANT LOAD; <br /> <br /> PHONE: ~ ~ -- ~ ~ ~ SITE NUMBER~ <br /> ~ VALUATION: <br /> <br />TYPE: ON-SITE SE~A~E ~ WATER SUPPLY: PW <br /> I .TEST HOLES READY: YES <br />PERI, IT OR APPLICATION NO: 98~,ai~2 J SITE EVAI_UATZON NUMBER: <br /> J EX~STING TANK ~IZE: <br />CONTRACTOR~ NO. ~6415 ~;J~ ~ I EXISTING DRAIN F'IELD LINES: <br />CHARLEY ltESS BACKHOE ~ J SEPTIC TANK PUMPED: <br /> <br /> ITEN ~UANTITY AMOUNT <br />SiTE E~ALUATION~ EA,, AD'L,, LOT 1 $240,,9~ <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$240.00 <br /> $0,,0~ <br />$240.00 <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: DARK, JOHN RECEIPT NO: 62694 <br />RI~CEIVED BY: dS .............................................. TYPE: CK ~HECK ~: 1417 <br /> <br />SEE ATTACHED DOCUHEHT FOR REQUIREHENT~ OF ON-BITE ~EWAGE SYSTEM. <br /> <br />I,![!Tl'£: THIS ~OES NOT G~ANT DR I~IPLY PERMI,~SION ~0 BUILD O, THIS PAR;EL. PLAiN'I,[; AKD <br />ONS FRUCTION FIZRHZTS ~UST.SE OBTAINE~ BEFORE .BUILDING OR ~EPTIC INSTALLATIOi~ ~E~'.I'NS. <br /> ....................... ............................. <br />REMARKS: SS: SE F'ARCEL. '~2, DIV'EDIH~ PABGEL ~I~:YE, S ~__ _ ~__ ~ ~ ~/. <br /> <br /> OFF~CE COPY <br /> <br /> <br />