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MARION COUNTY I~.ULLDJNG INSPECTION <br />SENATOR BLDG. NO. 225 <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 worl4 will be pedormed by s registered builder', <br /> Other <br /> [ have read an~ agree ~e 1ecrus ~tat~'On t~e ~everse ~ide ol ~ATE~ .................................... <br /> <br /> D~TE: 09/05/92 T~HE: [0:14:50 <br />;ow~n: SMITH, HAROLD H ....................... T't~iS~4'g26'6'6 ............ ~dA~T-i'h-~' ~ <br /> <br /> AODRE~ .................. ~ ~ONSTRUCTION TYPE: ' ' ....... !'6~U>Ahd*; ......... <br /> ~[50 SMITH RD SE : <br /> <br /> j , <br /> o~ ~d~L~lh'~ZZ ......................................................................... :',0. oF <br /> <br />90~2 SMITH RD SE <br />AUNSViLLE, OR 97325 <br />PHONE: 749-2~45 ~ VALUflT[ON: <br /> <br />420Z4 <br /> <br />-92=02999 ................... <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATIQN <br /> <br />CONTRACTOR, NO. <br />SHITH~ HAROLD N <br />9032 SMITH RD SE <br />AUMSV~LLE, OR 97325 <br />PHONE. 749-2345 . <br /> <br />WATER SUPPLY: PW <br />TEST HOLE8 READY: YES <br />SITE EVALUATION NUMBER= <br />EXIST~N6 TANK SIZE= <br />EXISTING OR~N FIELD <br />SEPTZC TANY, PUMPED: <br />PREVIOUS NO. BEDROOH$: <br /> <br /> ITEM ' '. OURN¥ITY AHOUNT <br />SITE EVALUATION, FIRST LOT"' i $220.00 <br /> <br /> · " TOTA~..ASSE3$ED FEES $220.00 <br /> '' "' ;"' · :" ... ,:'}iPRE¥IOU$.RECEZPT$ <br /> · ..":,,.', ,:,..','/',':~,~'I,$ RECEipT $0.00 <br /> ' ......... $o.oo <br /> <br />PAYEE: "-".:'. .............. ,,L!,',': ..... ..: . RECEIPT NO: <br />RECEIVED BY: cZ___ . =:~:~"...'~:~.:':~:'~.:;..:~..."'!'' TYPE: CHECK ~: 0 <br /> ...................... <br /> <br />NOTE: THIS DOES NOT:GR~NT···OR.....~HPE.y··pERH[$$:ION,·:;TO'.·BU~D ON THIS PARCEL. PLANN[N~ AND <br />ONSTRUCTION PERHIT$ MUST 8E;'.OBTR.[NE·D·iBEFDRE $UI·ED[Na OR SEPTIC iNSTALLATION <br /> <br />REMARKS: SE / std.s~tem"'' '"' ' ' ..... <br />DONALD E. WOOOLEY, MARION COUNTY BUILDING OFFICIAL /, 8Y <br /> <br />. ¢o~,,,,~ ~-~ *~v. ,¢~ OFFICE COPY <br /> <br /> <br />