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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. NO. <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 />I am a reOistered builder 01~ ( I~e authorized representat ve <br />this docur <br /> <br />DATE; <br /> <br />, ODCUPANOY <br /> <br /> I,/~JATER SUF'PLY: PW <br /> /?! TEST HOLES RE~DY: YES <br /> SITE EVALUATZOt'I HUHBER:; <br />// ~ EXISTIN~ TANK SIZE: l~Oe <br /> tTXISTIN6 DRAIN FIELD <br /> SE. r.~C 'TANK PUMPED: <br /> PREV]DU5 NO. BEDROOMS: <br /> <br />188 <br /> <br /> ," AY ::.,=.. ,~ f AY 1 ON , <br /> <br /> SE~: ATI'ACHED bBCg: <br /> <br /> $ T~ZS tS HOT <br />F [g.,L,O¥iI big MUST <br />ht.[. NECESSARY <br /> <br /> / <br />/ <br /> <br /> / '!'OTAL ASSE$$EB FEES "'~ '$,.--,~,, ~K~' <br /> / F RE. VIOU,~ RECEIPTS $0. <br /> / THIS RECEI~ T ~, ,~, ,, <br />/ ...... ,':',-BAI:~I,ICE: DUE ~;~ ,, <br /> <br /> RECEIF'T NO: 6:.928 <br />TYPE: CK CHECK 4~: 1,5274 <br /> <br /> IqT F'DR REQUIREt4ENTS ~F ON,.,.SI'fE SEWAGE SYSI'E~4. <br /> THIS APPLICATIOH HOST GO THROU6H A REVIEW PROCESS WHERE THE <br /> O IT IS THE RESPONSIBILITY OF THE AFFL.~CAdT 7'0 A,~,~]~<,,. i'HGT <br /> QRMATiON HAS B~;EN RROY[DED., <br /> <br /> BY D6~,-,, ......................... CITY JUR:i;~D]iCTION: BY ........................ DATE ................. <br />S S'.; RPRr H~,.ht TH <br /> <br />~oat¢ # ~o ~s.s~ Rev, 4¢¢o OF F ICE COPY <br /> <br /> <br />