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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: SB8-$147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: S88-7904 <br /> <br />Other ....... <br />~ have read a~ agree lo the terms atated on the revere s de of <br /> <br />12235 WEST STAYTON RD <br /> <br />~ARION COUNTY <br /> <br /> TYPE: ON-SITE SE~tAGE WATER SUPPLY: pw <br /> TEST HOLES <br /> PERI~IT OR RPPL[~TIOH HO= ~892 SITE EV~LUAT~Ofl <br /> EXISTING TANK 8~ZE= ' <br /> COflTR~CToR~ NO. EXISTING DRRiN F~ELD L~NE~ <br /> WOOSLEY~ ~LLEN & K~Y ,u...:,? .- . .... ' I-'SEPTIC.T~NK <br /> ~ PREVIOUS NO. ~EDRoO~S: 2 <br /> <br /> ~T[M -'>,' ~' ' ~UANTITY A~OUHT <br /> AUTHOR~ZATIOH NOTIC~ -,,Fgg~,:'-~Z~,iT.:.. ,~ .,. ,,:.': ..... .. l <br /> <br /> PAYEE ....... ~:,,, .,. .... ,,. ........... ,. RECEIPT <br /> RECEIVED ~Y. PB ....... ~.~__~.,~;;~_;;=~__~ .... TYPE. CHECK ~. <br />........................ ..... .... ................................... <br />THZ¢ IS A V~Z~ PERN~T~i~q':~ZS',~T- ~$, 3~' ~AYS F~ I~ I~UE ~ATE. <br />CONSTRUCTioN FAILS TO MEET.'JAE[. REO'UI'RE~ENTS',OF 'STATE L~WS' AN~ HAR~ON COUNTY ~UILDING AND <br />ZDN2N[; OR~ZHAN~ES~ TH~S PER~T"'~H~b~.'~E~D~E' ~ULL ~ND..VOZ~,. ~ <br /> "'2/., ',,..':..:: .,"... '.'.,. ' ' '. '., '. ',' ', <br /> <br />R£HARKS. ALITH ' : " <br />J:}OI,!AL.D E. WOODLEY~ MARION COUN~ t~UIL'I)ING"OFFICI~I- / BY <br /> <br />OFF CE COPY <br /> <br /> <br />