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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: 588-514,7 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 888-7904 k ~ <br />I am performing work on a property I own or OCcupy. k,- % ,~t~,~ I~_.- <br />I am a regis ered builder OR he authorized representative S GNATURE OF APPL CANT~~ . ~ <br />The work will be performed by a registered builder, ~ ~ ~ <br /> <br /> 11844 V~CKI LAHE SE ~ <br /> <br /> PARCEL 1 THE RANLH <br /> r ~ITE NUMBER: 94-84588 <br /> PHONE: 7~.-5~6G ~ VALUATION: <br /> <br />TYPE: OH-SITE SEWAGE I WATER SUPPLY: PW <br /> ~ TEST HOLES READY: YES <br />P~-R/'fIT O~ APPLICATION NO: ~0~8~1 ~ SITE EVALUATION NUMBER: <br />CONI'RACTOR~ NO~ 36415 ~ ~[~ I EXISTING TANK SIZE: <br />,;HARLEY HESS BACK~'OE I EXISTING DRAIH FIELD LINES: <br /> <br /> PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM <br />S];TE EVAI.IJATION,~ FIRST LOT <br /> <br />TOTAL ASSESSED FEES <br />PREVIDU9 RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY AMOUNT <br /> 1 $288.88 <br /> <br />$288.00 <br /> $0.00 <br />$280.00 <br /> <br />~ALANCE DUE $0,,00 <br /> <br />PAYE'E: DARK~ JOHN RECEIPT NO: <br />RECEIVED BY: JS .................................... TYPE: CK CHECK ,f-: I417 <br />.~EI: ATTACHED DOCUMENT FOR REQUIREMENTS OF ON-'SI.TE SEWAGE .SYSTEH.. <br /> <br />REMARKS: SSi; SE~PARCEL ~,DIVI]DXNG,~PARC~-:~ <br /> <br />OFFICE cOPY <br /> <br /> <br />