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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 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> DATE; 07/2~/92 T~HE: <br /> ..................... ......... <br />~'~FTO~'~S ....................................... ~ tON'S~UtY~O~" ~/ <br /> ~ : <br /> <br />~ ~6h~: ......................... ;-~6~5m16~: .......... <br /> <br /> ~[ ....................................... . ........................ <br /> ' SITE NUH~/R= 92-0~7~7 <br /> PHONE: 678-1456 VALUATION: <br /> <br />......... i. c,~,~ N T Z A L <br />"' i OCdUPANCV: <br /> <br /> · OCCUPANT <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERHIT OR APPLICATION NO: 9041467 <br /> <br />CONTRACTOR, N0~ <br />ZACHER, GALE <br />SANE <br /> <br />PHONE: 678-%456 <br /> <br />WATER SUPPLY: PN <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: 1000 <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUNPEO: 7/23/92 <br />PGEYIOUS ,NO. 8EOROOHS; ~ <br /> <br /> ITEM QUANTITY AMOUNT <br /> AUTHORIZATION NOTICE - FLD. VISIT I $130_00 <br /> <br /> TOTAL ASSESSED FEES $1,30.00 <br /> PREVIOUS RECE[PT~ $130.00 <br /> THIS RECEIPT $0.00 <br /> <br /> BALANCE DUE $0.00 <br /> PAYEE: ' ~'lk ',~, · ' . ' ' RECEIPT NO; <br /> <br /> SEE ATTACHED DOCUMENT FOR REQUIREMENTS OF ON=SITE 8EN~GE SYSTEM. <br /> <br />· THIS IS NOT A PERMIT. T~lS APPLICATION HUST 80 THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE COHPLETEO. IT IS TBE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY IN¢ORHAT~ON HA8 BEEN PROVIDED. <br /> <br />REMARKS: AUTHORIZATION FIELD ¥IS~'f <br /> <br />CITY JURI$OICI'ION: BY_ ............ DATE .................. <br /> <br />OFFICE COPY <br /> <br /> <br />