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MARION COUNTY BUILDING iNSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGQN 97301 <br /> <br /> PHONE: 588-5147 8:00 ~ 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />~ am a registered builder OR ( ) the authorized representative <br />Other <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document, <br /> <br /> 6AGATKO~ DONALD J, ,90~.60-475 ~ESlDENT:[AL <br />SITUS ADDRESS; [ CONSTRUCTION TYPE; i OCCUPANCY: <br /> <br /> OCCUPANT LOAO; <br /> 150 SC0TT AVE ~ CONTRACT CITY; <br /> DETROIT OR 97342 DETROIT ~NO <br />USE OF BUILDING'. <br /> <br /> P,. 0.~OX 577 ..___~7'~.Q~__~D._~ .................... <br /> ~ETR0~T, OE ~7342 SZTE HUNBER= 94-~914 <br /> PHONE: V~LU~T[0N= <br /> <br /> , <br /> /2 <br /> 5 <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERH[T OR APPLICATION <br /> <br />CONTRACTOR~ NO. <br />GAGATKO, DONALD J. <br />P.O. BOX S77 <br />DETROIT~ OR 97~42 <br />PHONE: <br /> <br /> WATER SUPPLY: CW <br /> TEST HOLES READY: YES <br /> SITE EVALIJATION NUMBER: <br /> EXISTING TANK SIZE: <br /> EXISTING DRAIN FIELD LINES: <br /> SEPTIC TANK PUMPED: <br />J PREVIOUS NO. BEDROOMS: <br /> <br /> QUANTITY AHOUNT <br /> PERMIT RENEWAL - NO VISIT i $95.00 <br /> <br /> TOTAL ASSESSED FEES $95.00 <br /> PREVIOUS RECEIPTS $95.00 <br /> THIS RECEIPT' $0.00 <br /> BALANCE DUE ~0,,00 <br /> <br /> PAYEE: INVOICE NO: <br /> RECEIVED BY: CL_ .................................. TYPE: CHECK ~: 0 <br /> <br /> SEE ATTACHED DOCUNENT FOR REQOIREEENTS OF ON-SITE SEWAGE SYSTEM, <br /> <br /> ~ THIS i~ A VALI9 PER~IT ~ T~IS P£R~IT EXPi~S .~&8 DAYS FROM ITS ISSUE DATE. IF <br />CONSTRUCTION FALLS TO MEET ALL REOUIEEMENTS OF STATE LAWS AN~ MARION COUNTY BUILDING AND <br />ZONING ORDINANCES, THIS PERMIT SHALL BECOME NULL AND VOID. <br /> <br />REMARKS: SEPTIC RENEWAL,FOR PERMIT · J2506:- PERMIT ~ 40418 10-6-¢4 RECORDED EASEHENT <br /> RECVD ~ ~ ~ ~T .... '' <br /> ' ' OFFICIAL'/ BY ...................................... ~ <br />DONALD E,, W00DLEY, MARI0-'"-0UN--::~:~BUL-.H6He <br /> <br />OFF~CECOPY <br /> <br /> <br />