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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />:~20 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 />SIGNATURE OF APPLICANT: .................... <br />DATE: ........ ~ .......................... <br /> <br /> - .............. ~ -L~~f: '~ b~O~v:- <br /> <br /> DETROIT OR 97342 ~ETRDIT jNO <br />osaoF ~UILD~N~. ~ NO O~ a~b~66us:- <br /> <br /> P.O. BOX ~77 <br /> PHONE: VALUATION~ <br /> <br /> TYPE= ON-SI~ S~GE HATER SUPPLY: C~ <br /> TEST HOLE~ READY: YES , <br /> PERNIT OR ~CATION NO: 47~1 ~ITE EVALUATION NUMBER. <br /> EXISTING TANK SIZE: <br /> COHTRACTOE~ NO. EXISTIN~ DRAIN FIELD LINES: <br /> ~A~A~KO. DONALD J~ ~ S~PTIC TANK PUMPED: <br /> P.O. ~OX ~77 ,,~: ' ~"" ...... ' ....." ,' PREVIOUS NO,' <br /> DETROIT, OR 97342 v <br /> PHONE= <br /> <br /> PERMITITEM~ENEWAL ~ '"' ( ~--- T'~--~ .................. T AMOUNT <br /> · · · $95. <br /> , "':.'". ': ','~, ' '. '"',' T~TAL ~ASSESSED FEES <br /> <br /> ",. :.. ;.,'..',. ',,, ..... , <br /> .... ;, <br /> <br /> RECEIVED DY= CL INVOICE <br /> ................... .~ ...... ~-~ .............. TYPE. CHECK ~3 <br /> ~EE ATTACHE~ ~OCUHENT FOR'.~E'QUI'RE~TS ~.ON~SITE', SEWAGE. ~YSTEM, <br /> <br /> REMARKS~RECVDSEPTIC RENEWAL .FOR. . PEr, IT. '. · :..325B&,~ -~ PERMZ'Ti <br /> 'I ·: t 4~419. 1~-6-94 RECORDED <br /> DONflL~ E. WOODLEY, M~[DN'"~OUN~Y'~Ui~N~>OFFiCZ4L.,"~ D?' ' <br /> <br />OFFICE COPY <br /> <br /> <br />