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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 <br />CODE-A-PHONE 4:30 P.M, - 8:00 A,M. <br /> <br /> I have read and agree to the terms stmed on the reverse side of <br /> <br />DATE: 08/13/87 TIME: 9:51:05p <br /> STONER, M. <br /> <br />TAX ~.OT: <br /> 2834-2075 <br />CONSTRUCTION TYPE: <br /> <br />CONTRACT CITY; ; UGS: <br /> <br />~ATEGORY; <br /> RESIDENTiAL <br />] 0CCUC'ANCY: <br /> <br /> 20792 FILBERT STREET NE I OCCUPANT LOAD: <br />AURORA OR 97002 <br /> !.....NO <br /> <br />~ONE: 678~5497 v ~ ¢ ~ t i SZTE NU~ER: 2166 <br /> <br /> ~3 ~ 4$ ]W ~ 3 <br /> ', NO ~ NO <br /> <br />TYPE: ON-SITE SE~GE <br /> <br />PERMIT OR APPLICATION NO.' <br /> <br />CONTRACTOR, NO. <br />STONER, M, <br /> <br />PHONE: 678-5497 <br /> <br />9003712 <br /> <br />WATER E~PpLY: CH <br />TEST HOLES <br />SITE EVALUATION NUNSER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BED~: 0 <br /> <br /> ITEM <br />SITE EVALUATION, FIF~,T LOT <br /> <br />TOTAL ASSE~ED FEES <br />PREVIOUS RECEIPTS <br />TH[S.'RECEIPT <br /> <br /> BALANCE BUE <br /> <br />PAYEE: STONER, M. I'NVOiCE NOs <br />RECEIVED BY: dm ........... TYPEs. IN CHECK <br /> <br />SEE ATTACHED DOCUMENT FOR REE~IRENENTS;OF'ON-SITE SEWAGE SYSTEM. <br /> <br />QUANTI~Y AMOUNT <br /> $165.00 <br /> <br /> $165.0D <br /> $0_00 <br /> $165.00 <br /> <br /> $o,oo <br /> 43Ol <br /> <br />NOTE= THIS DOES NOT~¢~ OR 'rl~L~_y ,~IqqI04, ,,T,? ,BUILD ON THI$ PARCEL. Pt. ANNIN6 AND <br /> BE ,08T~I.ED BEFORE ,'B~ILDINIB OR .~PTI¢ I~T~TI~ B~I~. <br /> <br />RE~R~: SITE EVAL '' <br /> <br />fORM # MC I!,!~s ney ~m~ OFFICE COPY <br /> <br /> <br />