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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> ............. .......... , ..... <br /> DATE: <br />~"6~N~ ~". ........ <br /> ~AUSCHER, NORHAN & C~EOL 710$O-l~O <br /> <br /> PHONE: 58~-5147 ' S:O0- 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />DITTER HILLS f2 <br /> <br /> 31TE NUMBER: 92-02735 <br /> VALUATION: <br /> <br />~05 W. REGIS ST <br />STAYTON OR 9758~ <br />PHONE: 769-2092 <br /> <br />WK~78-8486 <br /> <br />,CATEGORY; <br /> RESIDENTIAL <br /> <br />QCDU'PAN~ LOAD: <br /> <br />TYPE= ON-SiTE <br /> <br />PERHIT OR &PPLICRT[ON NO: <br /> <br />CONTRACTO~ N0.,.02245 <br />Eddie L Wilson <br />4077 State St <br />Salem, 97501-5486 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TAN~ S,IZE: <br />EXISTING DRAIN F~ELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO, BEDROOMS: <br /> <br />9041505' <br /> <br /> ITEM QUANTITY AMOUNT <br /> STANDARD ON-SITE SYSTEH <br /> <br /> · TOTAL .ASSESSED FEES $210.00 <br /> PREVIOUS RECEIPTS $0.00 <br /> .THIS RECEIPT $210.oo <br /> <br /> BALANCE DUE $O.00 <br /> <br /> PAYEE: Eddie L Wilson RECEIPT NO: 4~558 <br /> CHECK <br /> RECEIVED BY: PW ............ TYPE: CK <br /> <br /> SEE ATTACHEO DOCUMENT FOR REQUIREMENTS OF'ON-SITE SEWAGE SYSTEM. <br />= THIS IS NOT A PERHIT. THIS APPL.iC~TIDN MUST 'GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE COMPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORMATION HAS BEEN,PROVIDED. <br /> <br />PLAN REVIEW~ BY ...... DATE .......... <br />REMARKS: NEW INSTALLATION <br /> <br />CITY JURISOICTION~ BY ........ OATE ........ <br /> <br />OFFICECOPY <br /> <br /> <br />