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MARION COUNTY BUILDING INSPECTJ~7 <br /> <br /> gale~ OR 97~0 ! IJ ~.~ <br /> <br />2; (~o~tractor Info matl01l ............... <br /> <br /> Core'orVal IDSF- Daily Sew'~a~e Flow~ ....... $ <br /> Site Ewl~.uat~..~0n~ fi~t 1000 ~I. DSF 245.00 20.~ <br /> ,,, ~q~Stmctlon & ~air P9~ ........ ., <br /> $24~,00 ~;,~[~ e~h ~dl. 5~ gal DSF ~0.~ <br /> ~y Water Was~ <br /> ~{~!~ing Tank 245~ <br /> ~ros~u~ Diatfibufio~ ..... 350,00 I0,~ <br /> Seepage ~h '245,~9' I0.~ <br /> P~an ~V;eW <br /> AItemtion~ 245&9 10~ <br /> <br />~lhofi~t/Oa NOti~ (~eld ~sit) ' 15030 . I0,~ <br /> Authofi~n N~ice ~o ~eld v~g~t) .... ~5,~ 10.00 <br /> ~n.ual Evaluation' ofAl~m~e $Vacm 150,o0 · 10.00 <br /> ~mp~r ~c~ Insp~tlon~ <br /> <br />(Mark I£Appllcabl¢ lo fills Ap~li~ion) <br /> Te~l Holes {t~ Dug <br /> will call when T~t Holes Dug <br /> <br />( ) I am performing wor~ on a pmper~r I o~n et o~¢upy <br />(V~ am a ~egktCtt:d builder o¥ ( ) Ihe autho~zcd *:pm~atalive <br />( ) The work will b~ pcrforca*4 by a DIgQ Liecn~d Installer <br />( ) OI~cr <br /> <br /> ntt I ' 'v ' $ <br />..... Sit~ l~wlu~o~ t~t lot 24s,oo <br />O~ W~t ~1 Sump 120.~ t 0,~ <br />~le ~ng 350,00 10.00 <br />.A~mfio~ 245+00 10,~ <br />Repair, ~r (rank) 75-00 <br />Con~o~.~q~it ~n~O F e d V s t) 85,~ 10.~ <br />~o~oa No~ (Fie d V ~ 0 150.00 <br />AuthOfi~ion No,ce ~o ~ield visit} 85.00 10,0~ <br />~gt fl~ S~m ~uahou 150,~ 10,00 <br />Annu~ gv~u~o~emp_ Or ~a~ship MH 90,00 <br /> <br /> · , ReceiptNo. <br />I ago~ lo mgall ~cO0lmg to the ~nthmifl~d pinna and spvoifiCmliOn~,, the l~ws <br />vi'the 8tat~ of On~gon and the o~dinane~s of Marion County, <br /> <br />NAME OF AIq~LICANT (please <br /> <br />SIGNATURE ~' ZPPI~ICANT. <br /> <br />MC I5-SI REV 2/93 <br /> <br /> <br />