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MARION COUNTY BUILDING INSPECTION <br />SENATOR SLDG, NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:80 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performirl9 work on a property I own or occupy. <br />lama registered builder OR( ) the authorized representative <br />of 8 re~istered builder. <br />The work will be Pertormed by a registered builder, <br />Othe¢ <br />I have read and aoree to the terms stated on the reverse side of <br />this document. <br /> <br />;°WNE~ATE: .t0121/94 <br /> <br />: s TUS ~E~f~ CHUCK <br /> <br />C~TE~ORY: <br /> <br /> 8351 KASA LN -- <br />AUMSViLLE <br /> <br /> SiTE NUMBER: 94-~3494 <br />PNONE: 749-2~79 VALUATION: <br /> <br />TYPE: ON=SITE SEBAGE <br /> <br />PERHIT OR APPLICATIOH <br /> <br />CONTRACTOR~ NO. <br />BAKE~, CNUCK <br /> <br />PHONE:: 749-207~ <br /> <br />57961 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES REABY: YES <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM QUANTITY AMOUNT <br />SITE EVAL. UATION.~ EA. ADDL. LOT 1 $225.00 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$225.00 <br />$~-o.00 <br /> $0.00 <br /> <br />BALANCE DUE $8.08 <br /> <br />PAYEE:,.,, . _ RECEIPT NO; <br />RECEIVED BY: cl _ _ TYPE: CHECK ~: 0 <br />SEE ATTACHED DOCUMENT FOR REQUIREMENTS Of ON-SITE SEWAGE SYSTEM. <br /> <br />blO'T'E: TNIS DOES NOT 6RANT OR IMPLY PERMISSION TO BUILD ON TFII8 PARCEL. PLANNING AND <br />]NSTRHCTION PERMITS MUST ;SE OBTAINED BEFORE BUILDING OR SEPTIC INSTALLATION BEGINS. <br /> <br />REMARKS,, SE, MARg'[14A[~ FOR STANDARD WITH CURTAIN DRAIN, EFFLUENTF'~I~:'F' :'. FIELD STAKEOUT <br /> RI...OU.[ RI:,D. <br />I)ONA[..I) E, WOODI.,EY,, MAr~ION COUNTY BUILDING OFFICIAL,. / BY <br /> <br />OFFICE COPY <br /> <br /> <br />