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MARION COUNTY BUILDING IN'SPECTION <br /> SENATOR ;~LDG, NO, 22~ <br /> 220 HIGH STREET NE <br /> <br /> ..... <br /> <br /> Z6~2~ H~RT~N LN . NE ~ ............................................... ; ............... <br /> ~UROR~ I]R <br /> <br /> ALOHA OR ~7~7 ,, SZT~ HU~BER~ <br /> PHON~ 62~-6~87 VALUATZON~ <br /> <br />................ ~'65~ ............ j S~OTION; ............. ~IP; ~ ~ANg~: ~ ZONe; ~ MAP: <br /> <br /> TYPE: ON-~TE ~AGE ~ATER ~UPPLY~ PW <br /> TEST HOLES <br /> PER~IT OR ~PLZCAT[Ofl NO~ ~5~ S~TE EVALUATION <br /> CONTRACTOR, NO. EXISTING DRAIN FIELD LINES: <br /> ~H~'TH~ ALaN ~ SEPTic T~NK PUMPE~: <br /> PO ~OX 6779 ' PREVIOUS NO, ~ED~OOH~ <br /> ~LOHA OR ~7~7 " '' '''~'' '"" : .... <br /> PHONE= <br /> <br /> .... ITEM_ , :' i ~'-' .' ' ' " LIUANTZT¥ AMOUNT <br /> ~(AHOARD t]I',(-SI"['E SYS'TEM , ..' ': ' ' " 1 $2,~5,~0 <br /> . '...i.': '.'" :.." ."'.' ..':: YOTAL...AS~SSED' F[~ ,2S5. ~0 <br /> :' '' .'' '"r :'. ' ' "'PREVIOUS' RECEIPTS SB. ~ <br /> · ~ ':.:..-.. :,,.~ '... ,~ ...:..-,,: :: ~'.'~c~:P~__. <br /> <br /> SEE AI'TAOHE~ DOCUHENT..FOR',i'REOJ~[~EN%S:,OFi,,'ON~S.iTE'.~WA'gE",~y~T~. <br /> . ..;~, -, ~,.., ,- , -- ~-. ,.- ....................................... <br />· ~l THIS IS NOT A P~HIT.:':,',,TH~."~g'~AI[~,',~T:[O-THEOUGH A EEVIE~ PROCESS ~HERE THE <br />FOLI,,OWIN~ ,HUST 8E COMPLETE,D,:'"':IT'.I'8,,T~E-', ,RES~ONS~LITY 'OF THE APPLICANT TO ASSLRE THAT <br /> <br /> .~': '.~',]:'.. S..Z. ':.:_._. '...'.." '. ".:." /: . <br /> . .... .. ............. <br /> R~MARK,~. NEW SEPTIC <br /> <br />OFFICE COPY <br /> <br /> <br />