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MARION COUNTY BUILDING INSPECTION
<br /> SENATOR BLDG. NO. 225 '
<br /> 220 HIGH STREET NE
<br /> SALEM, OREGON 97301
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<br /> 47 8;00 - 4;30
<br /> PHONE:
<br /> 24 HOUR CODE-A-PHONE: ~-79~
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<br /> O~TE: 09/08/92 TI~E:
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<br />~U~'~s: ............................................ ~ ~66~i6~'~ ~ occo'~NCv:
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<br /> ~UH~VILLE OR ~7325 { ~
<br /> ................................. ' ........................ ~ .................... J ..................
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<br /> 5Z[O RI~ER RO~D N ~[OOO
<br /> KEIZER 97~0~ OFFICE ~9~-~624 X-350 ~ SITE NUMBER: 92-0~199
<br /> PHONE: ~90-9~55 ~, VALUATION:
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<br /> ~ .................... k .................. ~ .................~ .................... ~ ................ r, ........
<br /> T~E: ON-SITE ~EWAGE WATER SUPPLY: PW
<br /> TEST HOLES READY:
<br /> PERM~ OR APPLICATION HO= 9042400 SIT~ EVALUATION NUMBER: 28245
<br /> EXZ~TZN~ TANK SIZE:
<br /> CONTRACTOR, NO. EXISTIN~ DRAIN F~ELD LINES:
<br /> ROSE, FRANKLIN SEPTIC TANK PUHPED:
<br /> 5210 R~VER ROAD N ~1000 ~EEVIOU8. NO. ~EOROOHS:
<br /> KEiZER 97~03 OFFICE ~93-~6~4' X-
<br /> PHONE:
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<br /> ITEM
<br />STANDARD ON-SITE SYSTEM
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<br />QUANTITY AHOUNT
<br /> I $210.00
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<br /> , ' . ' ' ..'TOTAl' ASSES'SRO.FEES $21o,00
<br /> · · .'" .',: ',,,",' '.i-PREVIOUS'RECEIPTS $0,00
<br /> : ....~ ,.::', ~, i-,,,,~ ,' "~- '" '. '.' ,.'-:'T~ } ~L',REgE,:I'PT.:: .: :" $21 O. O0
<br /> ' "'i ',,"F/!~'~'.. '"~:--~'.iL"F' ,";.i.,s~?.":.:' ,', ,i"-", '..:".'.-.': '
<br /> ,.., A CE..OUE'. $0.00
<br />PAYEE: ROSE, FRANKLIN ..... ~"i:~::'"':',""',,:';" '.'i..'.'. RECEIPT ND:
<br />RECEIVED BY: DM2_ '. ',' ' ' ..... '~'-:~....'.iii i'.. '... TYPE: CA CHECK ~: i006
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<br /> SEE ATTACHED OOOUHENT:.FOR'RE, QU,IRE~NT;3"OF,",ON~'$i']E. SEW~C-d.= .SYSTEM.
<br />F$ TH!SW ZS ~T ~ PERHZt, '"' Ya/$-A~ZCA~ZON',,~T.".eO;'. ~. ~ ~VZEW ~ocEss W,~ ;~
<br /> OLLO ING MUST BE COMPLETED....t.T' 13, THE".'R;~PON~IBI:~,ITY,~OF. THE APPLIOANT TO ASSURE THAT
<br />ALL NECESSARY INFORMATION HA8 BEEN P~QVIOEO. ' ' · . ·
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<br /> PLAN REVIEW: BY A E . ·CITY JURISDICTION; BY, DATE
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