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MARION COUNTY BUILDING INSPECTION <br />SENATO_R BLOC, NO- 228 <br />220 H'~GH ~Tl~EET NE <br /> SALEM, OREGON 87301 <br /> <br /> PHONE: 588-5147 8:00 ' 4:30 <br />,24 HOUR CODE-A-PHONE: 588-79~ <br /> <br />have read an~ ag~e~o the ~, staled ~n the r~ver~e side o~ <br /> <br />D~TE: 10/27/92 TIME: <br /> .................................................. , ~ ~; ......................... <br /> <br /> ZSHOP nO .......................... <br /> <br />: RESIDENTIAL <br /> <br />, O~V A^NI' <br /> <br />LO:T: <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERNZT O~ ~PPLZCATION NO: <br /> <br />CONTRACTOR~ NO. <br />FAGAN, ~ICHARO <br /> <br />PHONE: 74~-284[ <br /> <br />904~4&7 <br /> <br />WATER $UPPLY: PW <br />TEST HOLEg READY: <br />SITE EVALUATION NUMBER: <br />EXISTIN8 TANK ~IZE: <br />EXISTIN60RAIN F~ELQ LINES: <br />SEPTIC TANK PUMPED: NO <br />PREVIOU3 NO~ BEOROOHS: ? <br /> <br /> ITEM QUANTITY AMOUNT <br /> AUTHORIZATION NOTICE - FLD. VZ3IT I $1SO.O0 <br /> <br /> - TOTAL ASSESSED FEES SL~O.O0 <br /> THIS RECEIPT · ... so.oo <br /> <br /> PAYEE: RECEIPT NO; <br /> <br /> SEE ~T~CHEO OOOUHENT FOR REqUIREmENTS OF ON-SITE SEWAGE SYST~H. <br /> <br />FOLLOWINa HUST BE OOHPLETED. ~T lg THE EE~PONS'IBIL[TY OF THE APPLICANT TO A~SURE THAT <br />ALL NECESSARY INFOrMaTION Ha~ SEEN P~OVIOEO. <br /> <br />PLAN REVIEW: BY ........ .__.__ DATE.._.___~ ,,,.~,,.. CITY JURISDICTION: BY ......... DATE ........ <br /> <br />OFFICECOF? <br /> <br /> <br />