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.,, MARION COUNTY BUILDING INSPECTION <br />.~,~(~ ~(~D~ \ SENATOR BLDG. NO. 225 <br /> 220 HIGFt, STREET NE <br /> SALEM. OREGON'3JJ7301 <br /> <br /> PHONE 588-5147 <br /> CODE-A-PHONE 4:30 P.M. · 8:00 A.M. <br /> <br /> ol e registered builder. <br /> <br />OArE: 0~/05/~? T[H~; 6:40:Oga <br /> · IvlJs I C. <br /> <br /> 230 CENTER STREET <br />OETROIT OR 9?842 <br /> <br />S.~E <br /> <br />WIDTH: OE~M! AREA: <br /> 100 77 <br /> <br /> TYPE= '0N-SITE SE~/AGE <br /> fiEF-dY/IT OR APPLICATION NO=', <br /> CONTRACTOR, NC, <br /> ~J$IC, <br /> <br />??00.00 U,tTS: <br /> <br />9001g$$ <br /> <br />PHONE: <br /> <br />SIGNATURE OF APPLIGANT; <br /> <br />DATE! <br /> <br />~'AX LOT: <br /> <br />CONSTRUCTION TYPE: <br /> <br />DT ~ <br /> <br />CAT~GORY: <br /> R <br /> <br />10 <br /> <br /> SF <br /> <br />HATER SUPPLY: ON <br />TE~T HOLE,5 READY: <br /> <br />SITE NUNt~ER; <br /> VALUATION: <br /> <br />RANGE! ZONE: <br />N <br /> <br />SITE EVALUATION NUFSER: <br />~D<ISTiNG TANK SIZE: <br />EXISTING ORAIN FIELD LINESt <br />SEPTIC TANK PUMPED; <br />HOLDING TANK AGREEMENT: <br /> <br />AFFIQAVIT: <br />N!NTER ~ATER CHECK: <br /> <br />1163 <br /> <br />N <br /> <br />!05 <br /> <br /> ITEI~, <br />~EPA ~ R Q[,,fANT I TY A~JN'F <br /> <br /> TOTAL AS,S~EO.FEB $35.00 <br /> PREVIOUS RECEIPTS $0.00 <br /> ~IS RECEIPT $35.00 <br /> <br />PAYEE: rvDSIC, ~E'RT <br /> <br />INVOICE NO: <br /> <br />$0,00 <br /> <br /> R~:'~;f?)iVED ~Y: F.~ TYPE: IN CHECK ~': 2428 <br /> 0 <br /> SEE ATTACHED DOCUMENT FOR REgUIREMENTG ,OF ON-S~T~ SEWAGE SYSTEM. <br /> <br /> ,.~,..,,:,.,.,.,,¢,,..¢~'¢r'"'rc'=~:'"m~-'":.:" ' ' : <br />SPECIAL <br /> <br />* TH~ ~ NOT A' PE~IT. THm' 'A' "' ~" ...... - ................ ""'" <br /> i~,~-T-,~._~.>,I~5~ GO. TH ,,:A..REVIEW PROCEExS ~ERE THE <br />ALL NECE~ INFO~TI(2N HAS.' 8E~' ,PROV.[.D [..~¢ ~']E APPLTCANT TO A~RE THAT <br /> <br />REMARKS: ~EPTIC REPAIR ,'¢,:" .....'..:..'.,; 'r :",:.." '.: "' <br /> <br /> <br />