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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. NO. 225 <br /> ' · ' 220 HIGH STREET NE <br /> SALEM, OREGON 97301 FiL. E <br /> PHONE: 588-~147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 ~.~_~ <br /> <br /> i have read an~ agree to the terms stated on. tll¢;reverse std~ ~,~ DATE;_ - ......................... <br /> <br /> .rOWN£,: -[N~-l-~: ~z~[,~/~'ZF .... ;~'~'-'~'-':~:~'"-4~-- T~YT ................................. ~3~'~9F .......... <br /> F~]'TING, J~MES & MON~~ ~ ]~ RESiDENTIaL <br /> .... · ............................................. ................. <br /> AUMSV~LL~ O~ 97325MAR~ON COUNT~ NO ~ ~ · <br /> ~os~ b~o~'i~ '~ ~ : , ~o. OF <br /> ' -~- ' '" '~: _.i~.L__:_1 ........... i ......... :r ...... ~... <br /> <br /> CONT~CT~ 76~-2~82 ' ~ I SI~ HU~ <br /> PHONE: ' ~ ~ / VALUATION: <br />' ~; '"T~ ~,,,~: ~w,~.,~: ..... ~.~ "' ~o.~; ............. ~ ........ <br />........ ~ .... ~, ~ I .. , ~,., ~ ...... : ~ <br /> <br />TYPE: 'ON-SZT~ SEI~GE : <br />PERN~T OR APPL/CAT~ON <br /> <br />CONTRACTOR. NO. ~4~1& <br /> STAYTON SEPTIC <br />41255 STAYTON SCI0 <br />STAYTON. 97383. <br />PHONE~',267-23~2 <br /> <br /> ~TEM, ": <br />S~TE EvALuA~IO., FZR~.. <br /> <br />i 9~5442 <br /> <br /> PAYEE: STAYTON SEPTI{ <br />· RECEIVED'BY: PM <br /> <br />'SEE ATTACHE900CUMEN1 <br /> <br />N0'rE~ THI~ DOES NOT <br />ONSTRUCTION PERMITS <br /> <br />PLAN REVIEW: <br /> <br />REMARKS: <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: YES <br />SITE EVALUATION NUMgER: <br />EXISTING TANK SIZE~ <br /> STUN& ~RAIN FIELD LINES: <br /> <br />~UANT~TY AMOUNT <br /> i $265.~0 <br /> <br /> $0.00 <br />$26~,00 <br /> <br /> RECEIPT N0~ 577[0 <br />TYPE: CK CHECK ~: 14878 <br /> <br />THIS PARCEL. PLANNIN~ <br /> INSTALLATION <br /> <br />~Y ......... DATE ............ <br /> <br />FORM ~ MC 15.~ RE, V, ~o OFFICE COPY <br /> <br /> <br />