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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-$147 <br />CODE-A-PHONE 4:30 P,M, - 8:00 A.M. <br /> <br /> I am performing work on a property I own or occupy. <br /> I am a registered builder OR ) the authorized reDresentatlve <br /> of a registered builder, <br /> The work will be performed by a registered builder. <br /> Other. <br /> I have read and agree to the terms stated on the reverse side of <br /> this document. <br />DATE: 08/24/8? TIME: 8:31:53a <br />OWNER: BOOCK. BRIAN LOT: <br /> <br /> 8053 MILL CREEK RD <br /> AUMS'VILLE <br /> <br /> SAME <br /> <br /> PHONE: 749-2112 <br /> <br />WIDTH: J ~ 7 DEPTH: 300 <br /> <br />OR 97225 !DON'CRAGT C ~¢Y i UGB'. i OGGUPANT LOAD: <br /> ~RI~ ~UNTY NO <br /> <br />SITE NUMBER: 2195 <br />VALUATION: <br /> <br />i CATEGORY; COMMERICAL <br />;OCCUPANCY: <br /> <br />TYPE; ON-SITE SENAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />BOOCK, BRIAN <br /> <br />PHONE: 749-2112 <br /> <br />9759 <br /> <br />~'~.TER SUPPLY: PM <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER:- <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: 2-28-84 <br />PREVIOUS NO, BEDRCOf4S; <br /> <br /> $TEM <br />EXISTING:SYSTEM EVAL. RPT. <br /> <br />TOTAL ASSESSED FEES <br />:, P:RE¥:I:0US: RECE I pTS <br />i ::THIS ,RECEiPT- <br /> <br />QUANTITY .AMOUNT <br /> 1 <br /> <br /> %~0.00 <br /> 60+00 <br /> $0.00 <br /> <br />$0,00 <br /> <br /> RECEIPT NO*. <br /> TYPE: ' ; CHECK <br />iTE,', Sla~AGE, SYSCB~ + <br /> <br />,~FROM iT~ I~.SUE BATE. IF <br /> AND NARION COUNTY BUILDING <br /> <br /> <br />