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MARION COUNTY E,I.~,ILD{~G 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: ~ggs-7go4. <br /> <br /> OATE: 02/14/94 TIHE: <br /> <br /> ~771 ~RO~NELL DR SE i .......................... i ' <br /> .................................... ~s <br /> <br /> PHONE: , V~LUhT ION ~ <br /> <br /> , : <br />........ ~---~--~,~,.,~'- ' ~TER SUPPLY: P~ <br /> ~EST HOLES <br /> PERMIT OR RPPLIC~TIOH fl0: 905~8~ SITE EVALUAT[O~ NUHBER: <br /> EXISTING TAN~ <br /> CONTRACTOR. NO. 349~6 EXISTZN6 DRAIN FIELD LINES: <br /> ST~YTON SEPTIC SEPTIC TANK PUHpED: <br /> 41155 STAYTON SC[O DR SE ~ PREVIOUS ilO. <br /> STAYTON, 97385 ' [ ' <br /> PHONE ~ 769-2302 I <br /> <br /> [ TE~ QU~HT [ TY ~HOUHT <br /> REPAIR - HAJOR 1 $125.00 <br /> TOTAL. A~S~S~0 FEES $i25.oo <br /> PREVIOUS RECEIPTS $0.00 <br /> THI~ RECEZPT . $125.o0 <br /> <br /> PAYEE: STAYTON SEPTIC RECEIPT NO: 55544 <br /> SEE ~TT~OHED DOCUHENT FOE EE~U,~EHENT~,~E ,O~-~[TE SEH~E SY~TEH. <br /> <br /> FOLLOWINg MUST BE O0~PLETED: "~'~ IS]THE, RES~ON~B~LZTY"OF'THE AP~LZOANT TO <br /> <br /> ALL Ng~ES~ARY INFORMATION' M~ "BEEB' PAOli. OEO. <br /> <br />OFFICE COPY <br /> <br /> <br />