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MARION COUNTY BUILDING INSPECTION <br />SENATOR I~LDG_ NO. 225 <br />220 HIGH STREET NE <br /> RALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 B:O0- 4:30 <br /> 24 HOUR CODE-A-PHONE: ~88.7904 <br /> <br />[ t~ ~ te(~Jstered bufJder OR ( ) t~e authorize0 representative !~IGNATURI~ O~ APPt, ICANT~, <br />of a rogistered bu der <br />Other <br /> <br />08/06/91 TIME: <br /> <br /> SITE NUI~ ER: 1077 <br /> ........ ;~W~S~: ................ !'~ih?~ALDATiON'~': zb-~: ' ........... '-g-~bt ..... <br /> <br />4' ' ~Oh~*$: gS' ~ ~h~: LOT: 1~ oo~ ~ 5o <br /> <br />2 <br /> <br />PEP~,lll' OR APPLICA'rlL~N NO: 90:32751 <br /> <br />CONTRACTOR. NO+ 312 <br />EI~IERY ~ ~ <br />PO BOX 398 <br />STAYTON, ORE 97383 <br />PHQNEt 788-7751 <br /> <br />INATERE.~JPPLY: ~ <br />TE~'r HOLES READY: <br />SITE EVALUATIC?N NUIV~ER: <br />EXISTING TANK SIZE: <br />~.~(ISTING DRAIN FIELD LINE~: <br />~EPTiC T.N~ PUMPE0: <br />PREVIOJ~ NO. BED~: <br /> <br />[TE~ <br /> <br />PAYEE: ~ERY & SONS CONST. <br />RECEIVED BY= CL <br /> <br /> QUANT 1 TY AMOJNT <br />  · . 1 $80.00 <br /> <br /> ~,..'. . TOTAL'-A...~SE~560 FEES $80.00 <br /> k~" :PR~I~:, RECE~PT~ $0. O0 <br /> , <br />~ " ' THI~' 'R~EtPT <br /> <br /> ' <br /> <br />TYPE: CA CHECK ~t: <br /> <br /> SEE ATTAt..~ED OOCUMENT FOR REOU,,~R~',~[NTfS' OF ~IN-~ITE SI~IAL~E E~Y'~TEM. <br />* THI3 lS NOT A PEI~IIT. THai-~ APPLICATICH MU~T GO THROUGH A F~'Vi~ PR~ I~I-i~RI~ THE <br />I=OLLD~IN~ IvLIST BE COt.I~LETIEO+ iT I.~.THE ~iSILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NP--CESSARY IN~TION ~ "i~F_~N PROVIDED. <br /> <br />CITY JURISOICI'ION~ BY ............. OATE ................. <br /> <br />OFFICE COPY <br /> <br /> <br />