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MAR~ON COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />I am pet o~ ng work on a property I own or ~ccupy. SiG'ATURE <br /> <br /> THERR~EN, H~RRY . <br /> , ' ................................... i <br /> <br /> 7908 STONE F~EL9 CT SE <br /> <br /> , .. . , ,..,,. ............................. ~.. ................ <br /> 8TONE FIELD GLEN <br /> 777[ TERE4NCE L4NE ; ............................................................... <br /> AUHSVILLE ~73~5 WK 750-4552 SITE NUHBER: 92-03624 <br /> PHONE: 74~-26~5 VALUATION: <br /> <br />LOT: <br /> <br /> 4 <br /> <br />YYPE: ON-SITE SEWAGE <br /> <br />PERHIT OR APPLICATION NO= 9043155 <br /> <br />CONTRA~TOR, NO. <br />THERRIEN~ HARRY <br />7771 TERRANCE LANE <br />AUHSVILLE 975~5 WK 750-455~ <br />PHONE: 749-2666 <br /> <br />; ~6 : SS ~ 2W ; AR : 51 <br /> <br /> ~ATER SUPPLY: P~ <br /> TEST HOLES READY: <br /> SITE EVALUATION NUHBER: 7'-76-8 <br /> EXISTING TANK SIZE: <br /> EXISTING DRAIN FIELD LINES: <br /> SEPTZC TANK PUMPED: <br /> PREVIOUS NO. ~DROONS: <br /> <br /> ITEM QUANTITY ~MOUN~ <br /> STAND,RD ON-SITE SYSTEM i $210.00 <br /> <br /> T07[AL ASSESSED FEES $~10.00 <br /> PREVIOUS RECEIPTS $0.00 <br /> ' ..THIS: RECEIPT' .j $0.00 <br /> ~AL' uE $210. OD ~ <br /> <br /> PAYEE: [~ · . .. RECEIPT NO: <br /> RECEIVED BY: DH2 .... ~ -~ ' TYPE: CHEO~ ~: o <br /> <br /> SEE ATTADHED DOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEH. <br /> <br />· THIS I3 NOT A PERMIT. THIS.APPLICATION MUST GO THROUGH A REVIEN PROCESS WHERE THE <br />FOLLOWING HU~T BE COHPLETED. IT iS THE RESPONSIBILITY OF THE APPLICANT TO ASSUE~ THAF <br />ALL NECESSARY ZNFORHATZON HAS BEEN PROVIDED. <br /> <br />PLAN REVIEW: BY .......... DATE ....... CITY 3URISDIDTJ[ON: BY ........ DATE ............... <br /> <br />REMARKS: NEW STANDARD SEPTIC SYSTEH <br /> <br /> OFFICE COPY <br /> <br /> <br />