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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 />Other <br /> <br />DATE; <br /> <br />owN~)~'r E; 06/14/91 'r II',4E ~ <br /> EMERY. [;)ALE <br />SITUS ADDRESS: CONSTRUCTION TYPE <br /> <br />RESJ[ DENT ;(AL <br /> <br /> 9654 GOLF CLUB RB SE CONTRACT CITY UGB <br />AU~VJLLE OR 9'f:¢2'~ <br /> . . IVlARICN ,COUNTY NU <br />LJ$E OF BUILDING, <br /> <br />:OCCUPANT LOAD <br /> <br /> NO OF 8EDR00M5 <br /> <br />P.O. 398 <br />S'f'AYI"ON. OR 9'1'.583 <br />PHONE: 769--52'/'rd <br /> <br /> Si'T'E NUIc~JER: 1077 <br /> VALUA'rIr3N= <br /> <br />AC NO NO <br /> <br />I'YPE: ON-SITE SEWAGE <br /> <br />PER~i'I' OR APPLICATION NOt 32751 <br /> <br />CONTRACTOR, NO+ 312 <br />E/'4ERY & ,SONS C(.~$'F. <br />PO BOX 398 <br />STAYTON, ORE 97383 <br /> <br />WATER ~JPPLY: PW <br />TE~'F HOLES READY: <br />SiTE 6VALUA'fiON NU~ER: <br />EXI~'I'ING 'rANK SIZE: <br />E~Xi~'fJNG DRAIN FIELD L~NES: <br />SEPTIC 'rANK PUNPED: <br />PREVICOS NO. SEORO~: <br /> <br />ITEN qUANTiTY .,~'4OUN'[' <br />REPAIR - MAJOR 1 $80.00 <br /> <br />'ro'rALAE~EB <br />PREVIOUSRECEiPTS <br />THIS RECE[PT <br /> <br />$80. O0 <br />$80.00 <br /> <br />BALANCE DUE $0.00 <br /> <br /> PAYEE: RECEJR'f' NO: <br /> RECEIVED BY: CL2 .................................................. , ......................................... TYPE; CHECK ~ O <br /> <br /> SEE AT'YACkED BOCUMENT FOR REQUiRI~D&ENT$ OF ON-SITE <br /> <br />~ THlS tS A VAL1O ~If ~ THIS PE~tT ~P[~ 360 ~ F~ ITS t~E ~TE. iF <br />~T~Ti~ FAZ~ TO ~T ~ R~I~T5 OF <br />Z~ING O~iN~C~, THIS P~IT ~ALL B~E NULE'~D~iD. <br /> <br />R~F%ARKS: TANK & DRAiNF[ELD REPAIR R~6493 ~ ~ <br />BONALD E, ¥'¢.,Y-gDLE¥, 1'4AR~ON Cv. gUNTY BUILDING OFFICIAL / BY .......................................................... ~ <br /> <br />¢o~. ~c*~,~ R~, 4/~ OF FlOE COPY <br /> <br /> <br />