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MARION COUNTY BUILDING iNSPECTION <br />SEI,,,L~,,TOR SLOG, NO, 225 <br />~0 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 508-5147 B;OO- 4;30 <br />24 HOUR CODE-A-PHONE: 58G-7904 <br /> <br />DATE: .................. <br /> <br /> , RESJ~DENT IAL <br />............................. 7CONgr~d~f~6~'n'~: , <br /> i ' <br /> <br /> 9~9~ PORTER RD SE <br />~UH~VILLE OR 97525 <br /> <br />S~HE ~TE NUHBER: 92-0~4Z0 <br />PHONE: 749-2645 <br /> <br />1~4~R~N CObNTYi NO <br /> <br />TYPE= ON-SITE SEWAGE <br /> <br />PERHIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />WALLACE, P,P. <br />SAME <br /> <br />PHONE: 74~-264~ <br /> <br />9042766 <br /> <br />WATER SUPPLY: <br />TEST HOLES READY; <br />~ITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS-NO. <br /> <br /> ITEM QUANTITY AMOUNT <br /> ANNUAL EVAL. - TEMP OR HDSNP MH <br /> TOTAL' ASSESSED FEES $75.00 <br /> PREVIOUSREOE[PTS $0.0o <br /> THIS. RECEIPT <br /> <br /> PAYEE: WALLACE. P,P. ,F RECEIPT NO: 4484~ <br /> RECEIVE~ BY; CL TYPE: CK CHEC~ ~: 1458 <br /> ................ ~.~'-~__~ ........ ~ ....... ~..'~%~.. ......................................... <br /> SEE ATTACHED OOCUHENT FOR REQUIREMENtS-OF'ON'SITE SEWARE SYSTEM. <br />* THIS IS NOT A PERMIT. THIS'APPLICATION HOST GO THROUGH A REVIEW PROCE5$ WHERE THE <br />FOLLO~IH~ HUST BE COMPLETED. IT ~S THE RESPONSIBILITY OF THE APPLIC~HT TO ASSURE THAT <br />ALL NECESSARY INFORHATION NA~ BEEH?ROVIOEO. <br /> <br />PLAN nEVIEW: ,'~" ' O ,m~ ~? ~ <br /> .... <br />REMARKS: HARDSHTP RENEWAL, <br /> <br />· CITY.JURISDICTION: BY ..... DATE ................. <br /> <br />OFFICE COPY <br /> <br /> <br />