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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLOC, NO. 2:~5 <br />220 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 />The work will be performed by a ?eoiste~d builder. <br /> <br /> PHONE: <br /> <br />; <br /> <br />~ATEE ~UPPLY: P~ <br /> EST HOLES RE~DY: YES <br />SITE EVALUATION NUHDER: <br />EXISTING TANK S~ZE. <br />EXISTING ~RAZN FIELD LINES= <br />,SEPTIC.~ANK EUFlPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> IT'EH QUANTITY ANOUHT <br /> STAHQAED ON-SITE SYSTEM ""II:'.'''''' III '' ':. 1 $255.~~ <br /> SITEEVALUATION~ FIRSTL'OT'.. 'm ~I mm mmmm m'mm 1 $2~5.88 <br /> <br /> ~ :' I : :'' '~: - I, i i: ;i -~ B~J~.V~OUS,','RECEIPTS $0~ 80 <br /> ,' '..: .... "~ ''.:';:'"%H~':RE~P~'...' ' $5~0.00 <br /> ....... ,IIiII,i,,'.;¥'.~.':~.:.{BA~ANCE.."BOE .. P,;~ $8.0~ <br /> II II ;:II~' I ~ ~I I : 'II'I I I I'I '~I' II: ~I:I II I ~' I'III I II:III I I RECEIPT NO= 5.75! <br /> Ace EPTIC ..'ii,", ..' <br /> RECEIVED BY. PK " " .... TYP~] CK CHECK ~= 34~2 <br /> ~EE ~TACHE~ DOCUment FOR REQUIREMEN~ OF"ON;SITE SEWhGE SYSTEH~ <br /> ....................... ~ ..... ~r~-~-;-.-;~---~.~;.~ .... r ................................... <br /> <br />~OT£: TNI8 ~0~8 ~fll [~Nt.'.~R:..I~[¥~F£~,I~,~[~R.?~'.BflI~ 'OIq THIS ~RCE~. PCg~NI~[ ~HI) <br />r)H~TRUCTION P~RMITS MpST BE.OB~A~N~D.B~FO~E, 3UIL~IN[ OR SEPTIC INSTALLATION BE~IIqS. <br /> <br /> .......... ATE ............. <br /> RE~hRKS: SE ~ TH~R£A~Y '.,,SS:STP S¥~ <br /> <br />OFFIC~ COPY <br /> <br /> <br />