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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: 588-5147 S:O0.4:30 <br />24 HOUR CODE-A-PHONE: 58S~7904 <br /> <br />read e, n41Sgre~ to I.~¢ erms stated on me r~ver~e si~ of <br /> <br />~GNATURE OF APPUCANT; .................. <br /> <br />13750 CEDAR Cl' NF <br />AURORA, O~ 77~02 <br />PHONE; ~78-5777 <br /> <br />SITE NUI4BER-. 94-82725 <br />VALUATION: <br /> i hANGS: ; ZONE: ':'M~¢,. <br /> <br />TYPE: ON-SITE SEi~A[;.E ~ <br />PER~IT 01~ APPLICATION NO: ?~5&879 <br /> <br />COHTRACTOE ~ <br />KENDRICK H. HCINTIRE <br />1375~, CEDAR C'f NE .' <br />PHONE; 678-5777 <br /> <br />WATER SUPPLY: EW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXIST~N~ TANK SZZE: <br />EXIBTIN~ DRAIN FIELD L3;NES: <br />~EPTZC,TANK, 8~PEB: <br />PREVIOUS NO. BEBEOOMS: <br /> <br /> iTEH ::. : ~UANTITY AMOUN'f <br /> STANDARD ON-SllrE SYSTE~t '' i : I $255.0B <br /> '"'...i ", y ,'/TOTAL ~8ESSED FEES <br /> ....... ',.- PR,EV-~DU$ ~ECE,~P~S <br /> " "' '"...',' ". ',, J,',".. T~'RECEIPT .' $255.~ <br /> <br /> PAYEE: KENDRICK H, MCINTtRE'F':'~""'~'- '"' INVOICE NO: <br /> <br /> SEE ATTACHED DOCUMENT FORi..RE~U~REM~TS,iOF: ONrsICE ,$EWA6E <br /> <br />FOI_t. OWING MUST BE COMFLETE~; ",.~',,IS. ~HE' ,RESPON~IBi'L,IT.Y 'OF THE APPLIOANT lO Ag.~URE THAT <br /> <br /> ~; ,".: .i ,'. '.' '".." ,:. : . <br /> REMARKS: SSIP~(IPO~E,O RE~ <br /> <br />OFFICE COPY <br /> <br /> <br />