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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 8:00- 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> 10955 /'iix RD <br />...... AU~V,ILLE ...................... ~f~ ~7_;~ 2.~ ................. ~R: 1,0 N..CQUJ,JI~__ .~[0 .................... ~ ....... <br /> <br />SAME <br /> <br />PHONE: 749-1~54 <br /> <br />TYPE= ON-~ZTE ~E~aGE <br />CONTRACTOR~ NO. <br />PHONE: 74~-1~54 · . <br /> <br />WATER SUPPLY <br />TEST ~OLES ~EADY: <br />SITE EVALUATION NUMBER: <br />EXISTIN6 TANK SIZE: <br />EXISTIN~ DRAIN FIELD LINES: <br />SEPTIC'TANK PUMPED: <br />PREVIOUS NO, BEDROOfl~ <br /> <br /> ITEN " " QUANTITY ~MOUNT <br /> ANNUAL EVAL. ~ TEHP OR R~S'HP'-'NH,, ,,, ,, i $125.00 <br /> ' 'TOTAL 'A~5'ESSED F££~ $~25.00 <br /> "~EV$SU8 RECEiPtS $?0~00 <br /> <br /> PAYEEc " ... RECEIPT <br /> ~ECEZVED ~Y: C~ ....... ~ _ ........ L'_ .... TYPE~ CHE¢K <br /> SEE ATTACHED DOCUMENT ~OR/'RE~UZRE~ENT~.OF ON~$ITE,'SEWAGE SYSTEM. <br /> <br />F8L[.O~IN6 MUST BE COMPLETED, 'IT IS THE EESPDN$IOILITY OF-THE APPLICANT TO AS' <br />ALL NECESSARY IHFORHATION NAS ~EEN PESVI.DE~. - ....... ...' <br /> <br />£ THE <br />E THAT <br /> <br />PLAN REVIEW~ BY " DATE.'_.. '":"~"~.'"' '-~ZTY' JlJRISBI~TION: BY <br />REMARKS: NBSP/ TANK NOT P'~MPED..LT HA'fLED iO/19/941.CALLED MR MIX 1/30/95. <br /> OANCELE~/FORFEIT I2/28/95~0R .' <br /> <br />EXPIRED APP <br /> <br />OFFICE COPY <br /> <br /> <br />