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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PH0'N E 588-5147 <br /> CODE'A-PHONE 4',30 P.M, - 8:00 A,M, <br /> <br /> [}ATE: L'?/2,%/2'; <br />OWNER: <br /> <br /> ~AYi..OR, <br />SITUS ADDRESS: <br /> <br />t~.,:,o4 ~. ,.TA¥ O', ROAD <br /> <br /> CO~TRU~IfN ~RE: OCCUPANCY: <br />S~ 66'N1'~:~ Cl~: US~i ;OCCUPANT LOAD: <br /> <br />:SAM <br /> <br />:?ONE: 759-59';15 <br /> <br /> SiTE NUMBER: <br /> ,..,vt, <br /> V,a~. A, 0 <br /> <br /> : 3 9S ~W E :'i.; <br />, AREA: UNITS: ; iR~EG'. LOT: CORNER; <br /> 0,92303 AC x.%, :<:: <br /> <br />MAP: <br /> <br /> ,off iN.3iTE SEWAGE <br /> <br />PERMIT OR APPLICATION NC: <br /> <br />COi,,l RZ~CTOF,, NC <br />h?'t,,3R, CARF:OL L <br />SAMS <br /> <br />9003354 <br /> <br />)'CATER SUPPLY: DW <br />'TEST }'IOLaS <br />SiTE EVALUATZON NLI~ER: <br />EXISTING TANK SIZE= <br />EXISTING DRAZN FZEL.,D LINES: <br />SEPTIC TANK <br />PREVIOUS N(}. <br /> <br />EXiSTiNG SYS-FErq EVAL... Ri:'":'. <br /> <br /> TOTAL ,a~SES~E O <br /> PRF'ViOUS REC~i PUS $8. <br /> T}-!,~S RECE l <br /> <br /> ~IAL,ANC E Db~, <br /> <br />SER ATTACFiE[) DOCUMENT FOR NEOUZREI"/iD~TS OF ON-S!iTE!!$EI~AG£ SYSTEM_ <br /> <br />FOLL,OWiN6 ~*~-SST 8E C;O~¢LE?ED. ;IT -tS THE ~PONSIBILZ,at' OF iI~E APPL:C;ANT TO AS,%~RE %.AT <br /> <br />ALL NECESSARY INFORMATION HAS BEEN PROVIDED. <br /> <br />,_,z, Y JUR].SDiC'?' iON: *',',* <br /> <br />OFFICE COPY <br /> <br /> <br />