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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG,. NO. 225 <br /> 220 HIgH STREET NE <br />. ' ~ALEM, OREGON,7301 <br /> PHONE: 588-5147 8;0~ - 4:30 <br /> 24 HOUR CODE,A-PHONE. 588-7904 <br /> <br /> ),~047 HAPLE LEAF CT NE '~b'NF~AS+'Cm,'; ..... ::"OPA~ ....... <br />¢~U~O~A OR 9700'2 :;MARION COUNTY~ NO <br /> <br />~AME <br /> <br />PHONE: <br /> <br /> 2 .22 .. <br />105 570 59850 <br /> <br />RESIDENTiaL <br /> <br /> MAPLE LEAF ESTATES <br /> <br /> SITE NUtlBER; 92-04026 <br /> VALUATION= <br /> <br />SF ~ NO ,i NO <br /> <br />TYPE: ON-SITE SEWA6E <br /> <br />PERMIT OR aPPLiCATION <br /> <br />CONTRACTOR, NO. <br />PIERCE, TOH A BETH <br /> <br />PHONE: 578-1067 <br /> <br />90459[8 <br /> <br />WATER SUPPLY; PW <br />TEST ROLE$ READY: <br />SITE EVALUATION NUMBER: <br />EX[STING TANK SIZE: ~000 <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPEO: ~ <br />PREV OU NO..EORO0 S <br /> <br /> ITEM <br />AUTHORIZATION NOTICE - FLO. VISIT <br /> <br />QUAflTI~Y AHOUNT <br /> i $15D.00 <br /> <br /> TOTAL ASSESSED FEES $130,00 <br /> RREVIDU~ RECEIPTS <br /> TH~S RECEIPT $1~0.00 <br /> <br /> BALANCE DUE $0~00 <br /> <br /> PAYEE: PIERCE, T~M & E~%TH · RECEIPT NO: 45989 <br /> RECEIVED BY: MD~PS~_~_.,..,~ . .... _,,.._..,,~ TYPE: OK CHECK <br /> <br /> SEE ATTACHEO DOCUMENT FO~ REQUIREMENTS DF ON-SITE SEWAGE SYSTEM. <br /> <br />· T~IS IS NOT A PERMIT. THIS APPLIcaTION MUST ~0 TMROUGH A ~E~IE~ P~CESS ~ERE THE <br />FOLLOW~NG MUST BE COHPLETED. JT ~S THE RESPONSIBILITY OF THE ~PPL~C~NT TO ~SSURE THAT <br />~LL NECESSARY INFORMATION H~ ~EEN PROVIDED. <br /> <br />PLAN REVIEW: BY___~ DATE ~."'~"~--~-2~_ CITY JURISDICTION: BY ..... DATE ...... <br />REMARKS: AUTHORIZATION <br /> <br />OFFICE COPY <br /> <br /> <br />