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MAR)ON COUNTY BUILDING INSPECTION
<br />SENATOR BLDG. NO, ~5
<br />220 HIGH STREET NE
<br /> SALEM, OREGON 97301
<br />
<br /> PHONE; 588-5147 8:00 - 4:30
<br />24 HOUR CODE-A-PHONE: 588-79O4
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<br />I am performing work On e prol~erfy I OWl1 Or OCCUpy. .
<br />
<br /> .............. 3':'46 ...................................................
<br />: owW~'~',~TE~."~ 27~21~7y5 ~.~ ~'~0 ......... i TAX LOT; ,"EATI~OR¥:'
<br /> ......................... ........................
<br /> " ................
<br /> 10163 MILL C~EEK RD SE --
<br />....... ~y~..~' OR 97325
<br />
<br /> SA~E
<br /> ~ SITE NU~ER= ~4-0418~
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<br />............. ~-2~ J --~,,-,-:.,~0~----~, -~:-~--.,=,------- ~Yg~- ,,, ~ .................. ,,,;,,,;,',,
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<br />TYPE: OM-SiTE SEWAGE
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<br />PERMIT OR APPLICATION NO:
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<br />CONTRACTOR. NO. 34916
<br />STA~TON ~EPT~C
<br />411§5 STAYTON SCIO DR SE'
<br />STAYTON, 973B3
<br />PHONE: ?~9-2~02 ~
<br />
<br />9059244
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<br />WATER SUPPLY: PW
<br />TEST ~LES REAOY= YES
<br />SITE EVALUATION NUMBER~
<br />EXISTING TANK SIZE: 1000
<br />EXISTIN~ ~RAIN FIEL~ LINE~:
<br />SEPT[C~TANE PUMPED:
<br />PREVIOUS NO. BEDROOMS:
<br />
<br />180
<br />
<br /> ITEM '' ,. QUANTITY AMOUNT
<br /> ALTERATION I $280.00
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<br /> :. ' .... ~OTAL'A~SESSED"FEES $280.00
<br /> '" ,.,,,,~REVlOUS RECE,Z~S .. $255.00
<br /> ."'*,',,, ..-..:.':" · 'T~Z$ RECEIPT, $0.00
<br /> .,':,~..,':::.':-,,',i,',',,~ALANCE DUE ' $25,00
<br />
<br /> PAYEE: '. :'". ......... RECEIPT NO:,
<br /> REC~IVE~ BY: CR .... '..'. "..._~'~__L'....~,,' .... ......' ...... ,TYPE: CHECK $: 0
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<br />FOLLOWING MUST BE COMPLETED..' I-T:"'[$'TNE "RESPONSI~IEITY OF THE APPL~CflNT TO ASSURE THAT
<br />ALL NECESSARY INFORHATIOH N~S BE'~i~,'pROVI~EP~,, ' · '"
<br />
<br />PLAN REVIEW: BY .......... ~ATE ':""""' ' "" OITY JURISDICTION: BY DATE
<br />REHARKS; S~:RPR:MAJ:TH:READY. HOL~ PENBING. A~I~IONAL INFOEHATION FROM OWNER. SEE LETTER
<br /> DATED 11/27/74. EXPIRED/CANCEL/FORFEIT
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<br />OFFICE COPY
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