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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 /> Tile work will De performed by a registered builder. <br /> Other. <br /> <br /> J)AFE~ ].2/08/9'~ '" '"'" " ~"" <br />............................................... , . : <br /> <br /> ~1485 J~M,:S W~Y DR SE <br /> <br /> DI'f'FER HILL TRgC'rS <br /> <br /> PHONE: 74~-2~54 ~ V~LU~'rION;SITE HU~B[R~ <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION <br /> <br />CONTRACIOR~ <br />JOHHSOH~ <br />SAHE <br /> <br />PHONE: 749--2~54 <br /> <br />9~6B141 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTIN~ TANK ~IZE: 988 <br />EXISTING ~RAIN FIELD LINES: <br />SEPTZ6 TANI( PUHF'ED: <br />PREVIOUS NO. BEDROON$: <br /> <br />QUANTITY AMOUNT <br /> <br />EXISTING SYSTEM EVAL. RPT. <br /> <br />TOTAL, ASSESSED FEES <br />PREVIOUS, RECEIPTS <br />THIS RECEIPT <br /> <br />$185,.00 <br /> <br />$185,.00 <br /> $0,,80 <br /> <br />BALANCE DUE <br /> <br /> F',AYEE: JOHNSON,, GL, ORIA RECEIPT NO: 6~,74Z~ <br /> RF-;BEIVED BY: DP ................................................. TYPE:: CK CHECK ,~: 6268 <br /> SEE ATTAC. HED DO~UHENT FOR F(E"QUI~EHENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br /> * THis IS HOT A PER~iT. THIO APPLICATIOH HUST GO THROUGH A REVIEW PROCESS WHERE THE <br />¢'OLLOWJ[NG NIJ5'F BE COMPLETED. IT. IS THE .RESPONSIBILITY OF THE APPL. ICAHT TO ASSURE: TSAT <br />ALL NFCE,,,~AkY INFORMATION HAS BEEN PROVIDE~. ,, <br /> <br /> RI:'N~RI(S: I;~SE~NEED PUHI/ER FQR~ 12~8~ ~ <br /> <br />OFFICE COPY <br /> <br /> <br />