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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: 888-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: S88-7904 <br /> <br />I';I'PH:;:r .L,J,, 1 .,. :% <br /> <br />CATegORY; <br /> <br />TYPE~- OH-SI"I'E <br /> <br />PEI;~i'tZIr OR APPL'rCt~TtON <br /> <br />(,OH I ~AE101'4,, <br />.JE:! F F~EY~ CHASE <br />fJ52¢J N!'~ ti.;~: i'CR S'F <br />VANCOUVER~ ~A <br />PNONE,~ 2~,~6--695,-.~966 <br /> <br />WATER SUPPt.,Y:~ 8W <br />TEST NOLES READY:: <br />SITE EVAL,UAT]:ON NUN~ER~ <br />EX'rS'TIN[; TANK <br />EXISTING ~RA)iN F'[EL, D <br />SE:PT:lC ThNK F'UNPE~)~ <br />PREVIOUS NO., <br /> <br />I'f LN QUANTZTY AMOUNT <br /> <br />PERi, IT RENEWAL, .,- ,N9 elSI'f <br /> <br />TOTAl. AS!~ESSED FEE'S <br />PREVIOUS RECE:[PI'¢~ <br />TH'.T S, EEC[::[ P'T <br /> <br />PAYEE <br /> <br />,:rr:,;' 5 ,, 00 <br />¢ ,r/,.~,, 00 <br /> <br />BALANCE ])U[~ ,lu;~. 00 <br /> <br /> INVO;[I;E NO; <br /> TYPE,". [;HECK :iF ,", 0 <br /> <br /> ,.,,k Al IACHED DOI,,UM~_dT FOR REtlU][REMEfll'8 OF ON-SITE SEWAGE <br /> <br />(%N['fRLCT19N EA]L.S l'O ~ELt AI.,L RE.[~UIREMENIS OF STA'rE LAWS AND HARI'ON ¢OUN'FY <br />ZON,[Nf, ORQII,IANCESI~ THIS F'ER~tT 8}'IflLL BECOME NULl. AND <br /> <br />FORM ¢¢ MC 1 ~-1~6 REV. 4JgO OF FICE COPY <br /> <br /> <br />