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~TU~ Ao~'I~RsTUSH!~Z~ DAN ' <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. NO. 225 <br /> 22O HiGH STREET NE F i L ~.F,~ <br /> SALEM, OREGON 97301 <br /> <br /> PHONE:588-5147 8:00- 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 ~ ~ ~ <br /> <br /> ~T~O~Y: <br /> ................. co~,5~ ~: ...... O~T~g~ <br /> <br /> 188~1 ARNDT RD N~ <br />use o~ .u~qm'~RORA .......... OR-' .V7~2- · <br /> <br />'. MAR~ON-, BOUNTY:' "NO ....... : - . .o o, ~o,o~s: <br /> <br /> · SITE HIJNDEi~" 93-I~18D4 <br />............................. .V_ _~__L.'_d. ~,T ! ~ _N _~ .............................. <br /> <br /> FID .......... <br /> <br />TYPE: OH-SITE SEWAGE <br /> <br />~I~RMIT OR APPLICATION HO: <br /> <br />CONTRACTOR. NO. ~Z966 <br /> BO~ BACKHOE <br />17884 ARBOR GROVE RD NE <br />WOO~BURN. ~7071 <br />PHONE: ~01-i~0 <br /> <br />9947297 <br /> <br />WATER SUPPLY: F'W <br />TEST F~JLES READY: <br />SITE EVALUATION IIUMBER: <br />EXISTING TANK 8lIE: <br />EXISTING ~AIN F~ELB LINES: <br />sEPTIC TANK PU~P~: <br />PREVIOU~ NO, BEDROOMS: <br /> <br /> ITEM QUANTITY AMOUNT <br /> <br /> THIB RECEIPT $~J,~,~B <br /> BALANCE DUE $0,00 <br /> PAYEE: MARTUSHEZ, DAN RECEIPT NO~ 4~558 <br /> RECEIVED BY: PH TYPE: CK O~ECK ~: 240~ <br /> SEE ATTACHED DOCUMENT FOR R£QUIREMENT~ OF ON-SITE SEWAGE GYSTEH. <br /> <br />FDLLO~t,I~ MUST DE COMPLETED. ~T %S THE ~$POI,IS~ILZTY OF TH~ ~F'?L~CANT TO ASSU~E THaT <br />ALL NECESSARY INFORMATION HAB ~EEN PROVIDED. <br /> <br />ALTERATION <br /> <br />CITY JURISDICTION: <br /> <br />BY ............ DATE ..................... <br /> <br />oFFICB COPY <br /> <br /> <br />