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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />2~'0 HIGH STREET NE <br /> SALEM. OREGON 97301 <br /> <br /> PHONE: 58S-5147 8:00 - 4::~0 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> DATE." 8&/24/94 TIHE: <br /> ~OR~: .............................. ; ................. .' .............................................. CONSTRUCTION ~E ~d~AWdg: .... <br /> <br />'MAilING ADDm[SS; .......................................................................................................................: ~UBOIVISION: <br /> <br /> SITE NUHBER: '~4-B2;~B5 <br />PHONE: 749-,2.287 VALUATION; <br /> <br /> ~ 2& 8S ~2W AR <br /> <br />TYPE= ONJSZTE SEWA&E ....... <br />PER"~IZT OR APPLICATION <br /> <br />?NTRACT~ <br />~F'LU~ ~IKE ~ NANCY <br /> <br />PHONE: 74~,-22~7 <br /> <br />9~588~' <br /> <br />~ATER SUPPLY~ PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTIN6 ~AI~ FI~L~ LINES: <br />SEPTIC T~NK RUNPED: 5-?~ <br />PREVIOUS NO. ~E~ROOH~: ~ <br /> <br /> ~TEM ~. , , QUANTITY AHOUNT <br /> REPAIR - MIN0~ I $85.00 <br /> AUTHORIZATION NOTICE - NO VISIT, .... , I <br /> ,~,, ,'. ~0TAL,',~SSESSE~,',:FEES $188.00 <br /> · . <br /> <br /> PAYEE: !. ' ""'"':-:'.'......""' RECEIPT NO: <br /> <br /> SEE ATTACHED DSCU~ENT POE','REQU~RE~ENTS DF ON~S'ITJ~ .SEWagE BYSTE~. <br /> THIS IS NOT A PF_~I?. TN'IS ~PPE~CA~I[71;I ~UST' ~S TEEQU~H':=A EEVIE~ PROCESS ~HE~E THE <br />FOr. LOWING ~UST BE COHPLETEO. ''IT!IS THE ~ESPONSIBILITY 'OF THE APPLICANT TO ASSURE THAT <br />Al,,[. N~CESSARY INFORMATION NAS BEEN PEOVI~E~; ' <br /> <br /> RFHA~KS: SS~AU HINOR TANK RF..PL~GEMENT: <br /> <br />OFFICE COPY <br /> <br /> <br />