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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: 588-$147 5;00 - 4:30
<br />HOUR CODE-A-PHONE: 588-7904
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<br />I nm pertor~ttn{; work on a property I own Or O¢OUDy,
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<br />SlGNA?URg OF A~'PL CANT: ....................................
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<br /> DATE; .................. ~ ...................
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<br /> 11133 WEST STAYTON RI) 97325SE
<br /> AUNSVILLE OR
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<br />BLI-$Lbl ~: .....................................................
<br />
<br /> PHONE:
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<br />!WiSTH; IDEPTH; ......... ~J AREA:
<br /> ~46 ) 4t82~. ~ SF
<br />~ ............................. )
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<br /> CONTRACTOR. NO. 36949
<br /> AAA ~EPTZC SEEVZCE
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<br /> SALEM~ Y7387
<br /> PNONE: 378-7454
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<br />GZT£ NU~BER: 93-~3172
<br />VALUATIUN:
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<br />WATER SUPPLY: PW.
<br />TEST HOLES READY.
<br />SITE EVALUATION NUMBER:
<br />EXISTING TANK SIZE:
<br />EXISTING I)RAIN.FIELD LINES:
<br />SEPTIC TANK PUMPED:
<br />PEEVIOU$:-NO.;,.,'~EDRO0~S:
<br />
<br /> ITEM .. QUANTITY AMOUNT
<br /> REPAIR - MAJOR "' 1 $125.00
<br /> .i · ,','u ": $ 2s.00
<br /> '',.,,,,,.:......:. ,":,,,,PREV.I. OUS'~ECE'~PTS:~ $125.~0
<br /> : .'..'."., '. ,;:'2,,','.TH~S:REOE~PT,'...: .... $0.~0
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<br /> PAYEE~
<br /> · . .................. ~'"""%;:.':.:¥..',L'.'.':.,,..~,:~,>,,,.'!~::,'-::" ..
<br /> RECEIPT
<br /> N0:
<br /> RECEIVED BY.ci ~. ~'~:',"A:i'~:?~:;'.~'"':;;..-".~'"~.'i',,i,-,-;'". [,} TYPE: CHECK ~: 0
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<br /> KU~/IUN ~A L~ TO MEET',,A~L,REQU:~REME~TS,:~OF,:STA~E ~SAND MARION COUNTY BUILDING ANI
<br />ZONING ORI)INANCES, THIS:PERN~T,,,;,SHAEE.,':BE~OME, NULL'AND,i,VO~.D; '
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<br />REMARKS: SS/ NJR/RPR S~. FILTER - ,. :,.m, ... ,,,, A~
<br />~ONALI) E. WOODLEY~ NARION COUNT,Y BUI'~ING,OFFICIAE / Byj'_ ..............................~
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<br />COPY
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