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MARION COUNTY BUILDING INSPECTION <br />SENATOR IBLDG, NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE; 568-5147 8:00 - 4;:30 <br />24 HOUR CODE.A-PHONE: 58847904 <br /> <br />t bm a r~glsteve0 0uit0er OR ( ) he author :Zed tepresental'ive <br />Other <br /> <br />SIGNATURE OF APPLICANT: ......................... <br /> DATE~ ........................ <br /> <br /> ' ......... = 'T4k' E6f: ......................................... r~Y~b~9; .......... <br />~AL, LACE~ ROBERT & V~L~RIE ~ 735~-22~ ~RE~ID~NTI'AL <br /> <br /> 9657 ST~YTON RD SE ~ CONTRACT C(~ ..... ~ ............... [~0~A~-[6A6'; ' <br /> AUHSVILLE 0E 97325 H~RION COUNTY <br /> <br />SAME <br /> <br />PHONE: 769-3252 <br /> <br />i 2 <br /> <br />~ITE NUHBER= 94-BG725 <br />VALUATION: <br /> <br />YES J YES <br /> <br />CONTRACTOR. N0. 349~6 <br /> STAYTON SEPTIC <br />41155 STAYTON SCIO DR SE" ' <br /> <br />PHONE: 75~-2302 <br /> <br />~RTER SUPPLY' PH <br /> E~T HOLES <br />SITE EVALUATION <br />EXISTING TANK SIZE: 500 <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK ·PUMPED= <br /> <br />200 <br /> <br /> ITEM QUANTITY AMOUNT <br /> REPAIR - MINOR ' :'' ' 1 <br /> :: TOTAL ~SSES'SED FEES <br /> ,..,,',.,.:...':,..: PREVIOU~ RECEIPTS <br /> · ,.,, i <br /> '" ,"i. ','. -" , .: ,'>.."L .- "'. ... . '.' <br /> ............ ,';]h~iL~NCE' 9UR .... · .:' ~. <br /> PAYEE: .... . "'..:.::.,:,.',.,',:,,',: ........... ,......?d::.' RECEIPT <br /> RECEIVED ~Y: P~ <br /> ._ - ........ --~'-~:~-~-Lg~';;~:,' ..... ' TYPE: CHECK ~: 0 <br /> SEE ATTACHED DOCUMENT,FOR REDUIREMEN~',',bF·ON'rS·ITE· ~E~AGE SYSTEfl~ <br /> · THIS IS A VALID EER~tT *' TH~S"-':P~R~ZT"ExPIRES.'.36~.D~yS FROH ITS I~SUE DATE. IF <br />CONSTRUCTION FAILS TO HEE~, A~/'RE~UIREflE.NT$, ~F'STATE .~A~S AND MARION COUNTY ~U~ DING <br />ZONING ORDINANCES, THIS PER~IT'SHALL'Bg¢oME NUgL,~N9'VOID~ ' <br /> <br />REHARKSj HINOR REPAIR <br /> <br />DONALD E. WOODL,SY~ HA~ION COUNTY BUILDING OFr~L'IAL / BY <br /> <br />~onu ,~ u~ ~s.s~ .er. 4,~ OFFICE COPY <br /> <br /> <br />