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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 ~:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: ,588-7904 <br /> <br />of a registered builder. <br /> <br />.. PA'[E: 04/23/92 'r -* ............... <br /> <br /> AOAMS, ~ARK ~ 5ALLY 6[5962-000 <br /> <br />RE51DEN~ <br /> <br />DE'F~Z T OR 97342 <br /> <br />41~6 CALSK)N OR SE " ..... 1 ........................................................ <br />~.LFJ~, OR 9'1301 ,, <br />PHrANE: 3'f1-68'~? . ~iTE NUMBER= 92-01598 <br /> : VALUAT ION: <br /> <br /> .DI~PTHt ~ AREA: UNITS= IRREG, LOT; . CORNER; <br />102 109; 11118.. SF' : NOi NO <br /> <br />MAP; <br /> <br /> ]09 <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PER~IT OR APPLICATION NO: 9039573 <br /> <br />CONTRACI'OR. NO. 53586 <br /> CANYON C.'ONS'FUC'f' i CW <br />P O BOX 5? <br />~TAY'TON, 9'/'383 <br />!:"'HONE: ?69-2584 <br /> <br />WATER ~PPLY: P'W <br />TFE..RT HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXis'riN~ 'rANK SZZE: <br />F=XiSI'iNG DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUG NO, DEDRCOMS: <br /> <br /> z'rEM <br />SEEPAGE TRENCH <br /> <br />PAYEE: ADAJv~, SALLEY <br /> <br />TOTAL AE,SE,SSEO FEES <br />PREVIOUS RP..TJEiPTS <br />THIS RECEIPT <br /> <br />QUANTITY -! <br /> <br />BALANCE BUE <br /> <br />INVOICE NO: <br /> <br /> RECEIVE0 BY: CL Typ~= ~N C~ECK ~: <br /> <br /> SEE ATTACHED GYOCUM~gN'f FOR REQUiRE.~I~4T~, OF ON-$1TE SENAGE GY~T~. <br /> <br />~ THiS I~ NOT A PE~T. THZS A~iCAT[~ ~ST .~. TH~ A R~Z~ P~ ~ERE THE <br />FOLL~I~ ~ST ~E ~PLETEO., IT I~ THE ~IBILiTY OF THE APPLi~T TO ~RE THAT <br />ALL NEC~RY IN~TI~ H~ ~ ~VIDEO. <br /> <br /> A~:,~J N 'r <br /> <br /> $210_00 <br /> <br /> $o. oo <br /> <br />4]622 0 <br /> <br />PbAN N~VltW: BY,~,,,, DATE ~ CITY JURiSDiCTION: BY gATE <br /> <br />OFFICE COPY <br /> <br /> <br />