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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO- 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97801 <br /> <br /> PHONE: 588-5147 S:00 - 4:30 <br />24 HOUR CODE~A~PHONE: 888-7904 <br /> <br />The work will be gedormed by a registered builder <br />Other <br /> <br />51GNATU~E OF APPLICANT <br /> <br /> DATE <br /> <br />TAX LOT <br /> <br /> 10384 W~T STAYrON RD <br />AUt4~V[ LLE O~ <br /> <br />61575-000 <br /> NO <br /> <br />LOT <br /> <br />749-25~8 <br /> <br />' TOWNSHIP <br /> <br />RAN~{~LUAT [ ON -' ZON~ <br /> <br />EFU 62 <br /> <br />~TER .~JPPbY: <br />T~T HOLE55 READY.- <br />SITE EVALUATION NUNSER: <br /> <br />~XZST [N~ DRAIN <br />SEPTIC TN~K PU~PED= <br />PREVIOUS NO. <br /> <br />~WNUAL ~¥A[.. - TEI~IP OR HD~HP ~H <br /> <br />PAYEE; <br />RECEIVED <br /> <br />TOTAL AE~E~S~D <br />PREVIOU~ RECEIPT~ <br />THIS REC~[P] <br /> <br />(~JANTiTY A~IOUNT <br /> SBU,00 <br /> <br /> SB0.00 <br /> $6o.oo <br /> $o.oo <br /> <br />BALANCE CIJE $0.00 <br /> <br />RECEIPT NO: <br />CHECK <br /> <br /> tYPE: <br /> <br />3EE AT rACHEO [X~CI. IMf~3~T FOR REQUiRI~T~ OF ON--~ITE S~91E SYSTEM. <br /> <br /> THIS I~ A VALJ. D t~MIT ~ THIS Pt~iT EXPI~ 3RD DAY~ ~ ITS I~UE DATE. IE <br />(~]NSTI~Z(~ FAIL~ TO ~ AU. RI~,TR~'41~ O~ STATE LAt~ AND I~IART(~I CGUNTy BUILDING AND <br />Z~NING ORD~NANCI~, 1~41S PERMZT ~ BE~COME NULL. ~J~D VOID. <br /> <br />L.YJ~ALD E. WOODLEY, f~RiON COUNTY BUILDING OFFiCiAL / BY ...............................~ <br /> <br />OFFICE COPY <br /> <br /> <br />