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MARION COUNTY BUILDING INSPECTION <br /> SEN.~,TOR I~LDG, NO. 225 <br /> '~ 220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: ~88-5147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904. <br /> <br /> am ~ ~e~i~tered builder OR ( ) the authorize~ represematrve SIGNATURE OF APPLICAN <br /> o e reg s a~ed builder <br /> The w~r~ wltl be oer[o~me~ by ~ registered builder, <br /> <br /> p~T~..,. ~/~/_~_ ......... T~[,...~ ~ ................... ~ '~o~-' ............. ~o.~,, ,~: <br /> 3EFF~EY, CH~SE . ' 772-1~2 . t <br /> <br /> 125 FZR~T ~T · , , . - . , ~ ,. <br /> DETROIT O~ 9~42 IOETROIT NO ~ <br /> ............................... ~ ................... L.J ................ ~ · '~ ....' ' ' ....... <br /> <br /> ~ P~TTON ~DO~T~ON <br /> 5320 NN EST[R ST '' ......... <br /> VANCOUVER, WA 98663 : ~ITE NUMBER: 92-0~58 <br /> PHONE: 20~95~0~66 ;' VALUATION: <br /> <br /> ,,. 2 : 2 <br />:'~'t~; ...... 9-o ?-~ ~T ................. !'i~T~T ............... ~ O~'i~s~ --l']~:'[~fT- ~5~.~? ...............~'>' ". ~ <br /> <br /> TYPE: ON-SITE 3E~RGE , TEST ~OLE~ ~E~DY: ~ ,~' ' <br /> PERNIT OR APPLZOnTION NO: 9042675 SITE EVALUATION NUHBER; <br /> EXISTING TANK SIZE: <br /> CONTRACTOR, NO. EXISTIfl~ DRAIN FIE? LINES: <br /> JEFFREY, CH~SE SEPTIC TANK PUMPED, <br /> 5~20 HW ESTER ST PREVIOUS NO. BEDROOMS: ~ _ ~ _~ <br /> VANCOUVEr, WA 98663 <br /> PHONE: ~06-6~5-09~6 <br /> <br /> Z TEH ~UANT I TY AMOUNT <br /> SITE EVALUATION, FIRST LOT 1 <br /> <br /> TO~AL'ASSE~SED FEES $220. O0 <br /> P~EVIOUS: RECEIPTS $0~o0 <br /> TH,~S RECEIPT <br /> <br /> PAYEE: 3EFFREY. C~ ....... ": '. ' · .... , INVOICE NO: 44735 <br /> .= __ .......... <br /> SEE ~TT~OHED BOOUHENT FOR REQUIREMENTS OF' ON-S'ZTE 'SENAGE <br /> <br />NOTE; THIS DOES NOT GRANT OR.I~P~Y PERMISSION.I'O. BU~LO ON THIO PARCEL. PLANNING AND <br />ONSTRUOTZON PERMIT~UST BE OBTrAINEQ BEFORE BUILDING OR.SEPTIC INSTALLATION BEGINS_ <br /> <br />PLAN REVI~W: BY <br /> <br />OFFICE COPY <br /> <br /> <br />