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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 />of a registered builder, <br />The work will be performed by ~ registered builder. <br />Other <br /> <br />~];AGA'f'KO.j DONALD J,. ! 90260-475 <br /> <br /> ],50 SCOTT AVE I~'6Hi-'~%ET'STg] ....... <br /> DETROIT OR 77~42 ~ DETROIT <br /> <br /> P~TTOH 2N9 <br /> P.O. BOX 577 <br /> <br /> ~18 ~ LG~ 19234., SF · 10 ~ YES <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION 140: <br /> <br />CONTRACTOR., NO. <br />GAGATKO, ~ONALI)J. <br />P,.O. BOX 577 <br />,D..ETROtT~ )R 97342 <br />F NONE: <br /> <br />9847531 <br /> <br />WATER SUPPLY: CW <br />TEST HOLES READY: YES <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO~ BEDROOMS: <br /> <br /> I TE~ (~UANT I TY AflOONT <br /> I::'ERNIT' RENEWAL - NO VISIT I $95.00 <br /> <br /> TOTAL ASSESSED FEES $95,00 <br /> PREVIOUS RECEIPTS <br /> THIS' RECEll T <br /> <br /> PAYEE: 6AClA'TKO..DQNAL~ J. INVOICE NO: 49889 <br /> RECEIVED BY:: F'~2 ...................................................... 'TYPE: IN CHECK ~: <br /> SEE ATTACHED BOCO~ENT FQk,BEQUII<EMENT~ OF, ON-SITE SEWAGE <br /> <br />g T~IS IS ~OT A PER~iT.' THIS APPLICATION flUST ~ ,THROUGH A REVIEW PROCESS ~ERE THE <br />FOLL, OW?t~c, HUST BE COHPLETE~'.r' IT IS T~E RESPONSIBILITY OF THE AF'PLICANT TO AS5ORF THAT <br />ALI_ NECE,~ARY %NFORHATION ~AS BEEN 'PROVI9ED.~ ", <br /> <br /> PLAN REV:JEW: BY JURISDICTIOn: DY ............... DATE ........................... <br /> SSHARIKS= ,~E]-T F ,~cFE'i4]]'~ ;',,:'.~l~6 - NOTE F'ERH][T ~: 4e418 -- NOT VALID <br /> <br />FORM # MO t 5-$6 REV, 4/90 <br /> <br />OFFICE COPY <br /> <br /> <br />