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MARION OOUNTY BUILDING INSPECTION
<br />S~NATOR BLDG, NO. 225
<br />220 HIGH STREET NE
<br /> SALEM, OREGON 97301
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<br />..,FILE
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<br /> PHONE: 588-5147 8:00 - 4:30
<br />24 HOUR CODE-A-PHONE: 588-7904
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<br />The work w~l[ be pedormed by e registered builder,
<br />Other ,
<br />J have read and agree to the terms stated';En the rever~ ~tde of
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<br />DATE: ............................
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<br />;.6~N.EhTDA.T-~,:, ,, 02,/.1,8/.9¢ ..... ....... TZA,T,v,;- ,.,,,,$,,:,4,9,:,,,44 ............................................ TAX LOT:
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<br /> ~ WALLACE, ROBERT & VALARIw- 73500-220 :RESIDENTIAL
<br /> ~,'~},% Ai')6%~i ........................... -OONS¥8{JdTib-N ~'~FE~ .................... { OCCUPANCY:
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<br /> 9657 STAYTON RD SE , ! C~DNTFLaCT
<br /> AU~SVILLE OR 97325 jMARION COUNTY NO ,
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<br />~, ...........................................................................................,,.,,.,JU .c~ ^ocm~ !~U~6~?~6~i ........................................
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<br /> SAME
<br /> PHONE: 769-325~ ~ VALUATiONSITE ~NE~M~R:: 94-00725
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<br />-~,. ............ ~,~-~-~7 .......... ~ : .......................... ~.~ ............... L:_Y _~L_ ~.~U ............ J.~.
<br />[ ................... J ........................... g .......... AC ....... .............. L Jr3 ..........................................................
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<br />TYPE; ON-SITE SENAGE
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<br />PERMIT OR APPLICATION NO: 9053010
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<br />CONTRACTOR, NO. 34916
<br /> STAYTON SEPTIC
<br />41155 STAYTON SCIO DR
<br />STAYTON, 97383
<br />PNONE: 769~2302
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<br />WATER SUPPLY: PW
<br />TEST HOLES KEADY:
<br />SITE EVALUATION NUMBER:
<br />EXISTING TANK SIZE: 500
<br />EXISTING DRAIN FIELD hINES;
<br />SEPTIC TANK PUMPED: 2/15/94
<br />"'PREVIOUS NO;'BEDROOMS: 2
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<br />2O0
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<br /> ITEM QUANTITY ~OUNT
<br /> REPAIR - MINOR ..... 1 $g5.00
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<br /> , , 'ToTAL'A'SSESSED. FEES $85.00
<br /> ' '"' ' '.'PREVIOUS RECEIPTS.
<br /> '" ,:i/THIS RECEIPT'"': ' $85.00
<br /> ', ,"" .'"'.:.' B~ANCE "DU~ ' $o~ oo
<br /> AYEE. ROBErt & ~&R~WALLACE. ... . , ,, RECEIPT NO: 55470
<br />RECEIVED BY. MB :~:,~.,~:' , ':' .'".'..,, · ,.. , TYPE: CE CHECK ~:
<br />sss A?TACBE,0 DOC~EN?'FOR R~QOtRE~3~?.~ .0F.0~L~Z?~'SENAg~
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<br />FOLLOWING MUST BE ~O~LETED. IT I$ TNE RE~PON~BZLITYOF THE APPLICANT To
<br />ALL NECESSARY INFORMATION .HAS.BE~ PROVIDED.
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<br />PLAN REVIEW: BY ATE ::,~,/~, .
<br />REMARKS:
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<br />CITY JURISDICTION: BY DATE
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<br />~O~ # MC 15-$6 R~V, ~ 0 F FICE COPY
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