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MARION COUNtrY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 5~-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> am a registered builder OR ) the authorized representative <br /> <br />have read a~d agree to the re?ms stated on t~e e¢~Jd¢ ~ <br />th~s document, <br /> <br />SIGNATURE OF APPLICANT= ................ . , , <br /> <br />DATE! ................. <br /> <br /> EMERY & SONS <br /> P 0 BOX 398 STAYTOfl~ OR 97383 <br /> PHONE= 769-775I <br />................................; BLOCK: <br /> <br />SITE NUHBER: <br />VALUATION= <br /> <br /> ~ RANGE~ <br /> <br />94-02992: <br />.r~'5'~ .......... ~-~; .......... <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PEENIT OR APPLICATION ~0: ~057012 <br /> <br />CONTRACTOR. NO. : <br />SANTIAM GOLF CLUB <br />EMERY & SONS : <br />P 0 BOX 398 STAYTON~ 0E 97383 <br />PHONIC: 769-7751 , .'.' ..- <br /> <br />WATER SUPPLY . <br />TEST HOLES READY. <br />SITE EVALUATION NUMBER: NO <br />EXISTING TANK SIZE: <br />EXISTING DRA~N FIELD LINES: <br />~EP~C.-TANK PUMPED.- <br />PREVIOUS riO. BEDROOMS: <br /> <br /> QUANTITY AMOUNT <br />SITE EVIL, - FIRST IO00,'GAL',D~I-9. .' ...... , "', ..... · .... · I $280,00 <br /> ': ..... .TO,TAL, <~ ~,r~, F'EES.' ' "? ' " <br /> .... · ,, ,;,, ,,, ,,: ,,,,,, .:~SSE. S~ $~.o. O0 <br /> ' .................., ,., ,,',Il,.'_ ._..: .7.' ... jTHI$;~E~ETPT ..... ' $0.00 <br /> ': ' '"' '" ""' ~'~L;~NC'i~ f~_'" ' ,~s, oo <br /> <br />RECEIPT NO~ <br /> <br />PAYEE: <br />RECEIVED <br /> <br /> TYPE: CHECK f: 0 <br />SEE ATTACFIE9 DOCUMENT FOR REQU~RENENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br />NOT~: THIS DOES NOT 6RANT OR IMPLY PERMISSION TO ~UILD ON .THIS PARCEL. PLANNING AND <br />ONSTRUCTION PERMITS MUST ~F_ OBTAINED ]BEFORE ~UILDING OR S~PTIC INBTALLATION BEGINS. <br /> PLAN REVIEW: DY DATE CITY JURISglCT~ON: gY DATE <br /> RE~ . c' <br /> -,,ARKS..~E,. SOIL SU~STAN~AR~ fbR ANY SYSTEH. HIGHT BONSI~ER W~NTER HOL.~IN6 TANK W~TH <br /> OUTLET TO SHALLOW 'I'RENCHE~ DURING SUMNER SEASON. NEED ~6Q. DENIED 9/i4/94 <br /> <br />COPY <br /> <br /> <br />