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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEMt OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am a registered broider OR ) the authorized representative <br /> <br />The work wiU be performed by a registered builder, <br />Other. <br /> <br /> I CONTRACT CITY: <br />; ,, .20.5.' t_AKECREST ~)R -- i <br /> <br />MAILING <br /> <br />,:LOT: <br /> <br /> PATTON ADDITION <br />3475 BIEGLER I..fl S <br />SALEM, OR 97302 SITE <br />PNONE: ~64-~46~ VALUATION: <br /> <br /> , <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PEEKIT OR APPLICATION NO: 9859136 <br /> <br />CON'FRACI'OR~ NO, 3&42I <br />KEVIN'~ S ~ACKHOE <br />PO BOX 465 <br />DETROIT. 97342 <br />PNONE: 854-)7~7 <br /> <br />WATER SUPPLY: CW <br />TEST HOLES READY: YES <br />SITE EVALUATION NUNBER: <br />EXISTIN~ TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br />ITEM QUANTITY AMOUNT-' <br /> <br />SITE EVALUATION~ FIRST LOT <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />B~LANCE DUE <br /> <br />PAYEE: KEVIhPS BACKHOE <br />RE[,EIVE, D BY: PM <br /> <br />INVOICE ND: <br />TYPE: IN <br /> <br />I $2&5.00 <br /> <br /> $2~5,,00 <br /> $0.00 <br /> $26%00 <br /> <br /> $o.00 <br /> <br /> 61787 <br />CHECK ~: 0 <br /> <br />SEE ATTACHED I)OCUMENT FOR BEQUIREMENTS OF ON-SITE SEWAGE;SYSTEM. <br /> <br />NOTE: THIS DOES NOT GRANT OR IMPLY PERMISSION TO BUILD ON THIS PAROEL. PLANNING AND <br />O STROC'rION PER.ITS MOST O T ZNE ErO.E BUZL IN6 on SEPTZC ZNST~LL~TJON ~E6INS, <br /> PLAN RE:VIE~: ~Y ~Z~ ~AI'E Z~/¢~ CJT~ JURISDICTION: ~Y DATF <br /> <br /> OFFICE COPY <br />FORM ~ MC 15-56 REV, 4/9o <br /> <br /> <br />