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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. NO. 225 <br /> · ..J 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 />l am a registered builder OR ( ) thc authorized representative <br />of a registered builder. <br /> <br /> t25 F~RST ST ~_ ~ OONT"ACT CI~Y: j UGB: ~OGCUPANT LOAD: <br /> <br /> OETROZT OR 97~42 OETROIT NO <br /> *OF ~EOnOOVS <br /> <br />, 5~28 NW ESTER BT <br /> VANCOUVER. WA 9866~ SiTE NUHBER: 94-~481 <br />, PHONE: 2~-695~966 VALUATION: <br /> <br />TYPE~ OH-SITE SEWAGE <br /> <br />PERHIT OR APPLICATION <br /> <br />CONTRACTOR. biO. <br />JEFFREY~ CHASE <br />~320 HW ESTER ST <br />VANCO~VER~ WA 98663 <br />PHONE. 206-695-B966 <br /> <br />WATER SUPPLY: CW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS ~O. BEDROOMS: <br /> <br /> iTEM QUANTITY AMOUNT <br /> PERMIT RENEWAL - NO VISIT I $95.00 <br /> <br /> TOTAL ASSESSED FEES $95.00 <br /> PREVIOUS RECEIPTS $0.00 <br /> THIS RECEIPT $95.00 <br /> <br /> ~ALANCE ~UE $~.00 <br /> <br /> PAYEE: JEFFREY~ CHASE INVOICE NO: &1026 <br /> RECEIVED BY~ ~ .................................. TYP~ IN CHECK ~ 0 <br /> SEE ATTACHE~ DOCUMENT FOR REQUIREMENTS OF ON'SITE SEWAGE SYSTEM. <br /> <br /> ~ THIS IS HOT A PERHIT. THIS AP~PLICATIOH ~ gO THROUGH A REVIEa PROCE~ WHERE THE <br />FOLLO~JING MUST BE COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY ~NFORMAT~ON HAS 9EE~ PROVIDED. <br /> <br />PLAN REVIEW,. [~Y ..... i_ ._ ATE__/_ ...... <br />RENARKS: <br /> <br />FORM # MC 15-56 REV. <br /> <br />PERMIT RENEWAL: bi0 F/V .- PREV OUS %93-11,.~5 <br /> ~ v OFFICE COPY <br /> <br /> <br />