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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97901 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 P.M * 8'00 A,M. <br /> <br />/ <br /> <br /> I am · r~gIBtered b,Jilde¢ OR ( ) the authorized representative <br /> <br />~,IGNATURI~ OF APPLICANT <br /> DATE <br /> <br />oW~iIA~'E: 11/13/89 TTME: 11:49..47e <br /> <br />S,TUS ^D~.E~:~)'PACIF:[c RR (MEEKER FERTZL'tZER) <br /> <br />TAX LOT <br /> <br />CONSTf~UCTION ~PE <br /> <br />CATEGORY <br /> <br />OCCUPANCY <br /> <br /> 11598 MCCLELLAN RD <br />AUMSVILLE <br /> <br />OR 97325 <br /> <br />SE <br /> <br /> CONTRACT CITY UGB <br /> <br />MAR[ON COUNTY 'NO <br /> <br />OCCUPANT tOAD <br /> <br />0 <br /> <br />CONTACT: ART GROBE <br />1795 - ISTH ST SE <br />PHCNE: 769-2330 <br /> <br />SALE~ 973(]2 <br /> <br /> SECTION <br /> <br />SITE NUMEER: 8499 <br />~A~-UATION: zO.E <br /> <br /> 13 <br />1.00000 <br /> <br />AC YEE5 NO <br /> <br />AR <br /> <br />PE~ZT OR APPLZCATZON NO: 9020196 <br /> <br />CONTRACTOR, NO. 51352 <br />REA CONST. INC- <br />P.O. BOX 517 <br />STAYTON. OR g7353 <br />PHONE: 769-6566 <br /> <br /> ITEM <br />STD ONSITE SYS < 1000 GAL <br /> <br />PAYEE: REA C~NST. YNC. <br />RECEIVED BY= cl <br /> <br />HATER SUPPLY~ <br />TEE;T HOLES READY: <br />SITE EVALUATION NUIV~ER: 19311 <br />EX[STING TANK SZZE: <br />EX[ST[NG DRAIN FIELD LINES: <br />SEPTIC TANK <br />PREVIOUS NO. EEDRCOf,~: <br /> <br />TOTAg ,~.~-~i~.ED FEES <br />PREVZCU$ RECEIPTS <br />THI~ P, ECEZPT <br /> <br />C.XJANTITY AN(~NT <br /> 1 $165.00 <br /> <br /> $0.00 <br />$165.00 <br /> <br />BALANCE DUE $0.00 <br /> <br />RECEIPT NO: <br /> <br /> 2143S <br /> TYPE: CK CHECK ~t: 3931 <br />SEE ATTACHEO DOCUMENT FOR REQUIREMENT~ OF ~JTE ~E S~T~. <br /> <br />~L~I~ ~T eE ~. IT IS ~E ~IBILI~ OF ~E APPLI~T TO ~AT <br />ALL N~ IN~TI~ <br /> <br />RI~4ARY,~: ST[} ~Y~TEel R3t?946 <br /> <br />CITY JURISDICTION: BY <br /> <br />OATE <br /> <br />OFFICE COPY <br /> <br /> <br />