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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 />J am performing work on a property I own or occupy, <br /> <br />TAX &CT: CATEGORY: <br />dO~STRUCTION TYPE; OCCUPANCY: RESIDENTIAL <br /> <br />r4AR ION COUNTY <br /> <br />NO <br /> <br />OCCUPAN/' LOAO: <br /> <br /> P.O. 398 <br /> s'rAY'f'ON, OR 9'1383~'~ <br /> PEICNE: '169-5Z76 SITE NUF~ER: 1077 <br />LOT' ' ~LbC~; 'S~CTION: TOWNS,~P: ~N~LUAT ! ' ZbNE: <br /> <br />WIDTH: 'DEPTH: ; AREA: 4 : gNITS: SS ~RREG LOT: lW CORNER: EFU 60 <br /> 4~:? : AC NO NO <br /> <br />'fYPE; ON-SiTE SEWAGE <br /> <br />PERlv}i'I' OR APPLICATION NO: 9032751 <br /> <br />CC)NTRACTOR, NO. 312 <br />E~ERY ~ fSON~ OYONS'[', <br />PO BOX 398 <br />~TAY'fON, ORE 9?383 <br />PHONE: 769-7751 <br /> <br />WATER E~JPPLY: P~ <br />'FE~'F HOLE~ READY: <br />SiTE EWALUAI'iON NUfC~ER: <br />EXISTING 'rANK SIZE= <br />EXiSI'IN6 DRAIN FIELD LINES: <br />SEPTIC 'rANK PU~PED: <br />PR~I~S NO. BEDR~: <br /> <br />t'f'EH ~. Q~JAN'f'Z'FY A~OtJN'f' <br />R~PAiR ~ f~JOR f-~ 1 $so.oo <br /> ,, ¢ To'rAL ASS~EO ?E~ $8o.0o <br /> , PREViOUS:RECEiPTS <br /> 'FH[SRECEIP'F $80,oo <br /> <br /> ~.~/ BALANCEDUE $0.00 <br /> <br />PAYEE: ENERY & SONS CONS'['* <br />RECEIVED BY: OL <br /> <br />RECEZP'f' NO: 34543 <br />TYPE: CA CHECK ~: 0 <br /> <br /> SEE ATTACHED DOCU~4ENT FOR RE(~&REMENTS OF ON-SITE $~HABE SYSTE~4. <br />* THI~ i~ NOT A PEI;~I[T. THIS APPL[CAT[ON I~UST GO THROUGH A REV[iB~ PROCEE~ hHERE THE <br />FOLLOHINEi IvLIST BE COI~IPLETED. IT 1,'~ THE RE~PON$11BILiTY OF THE APPLICANT TO ~RE THAT <br />ALL NEC~RY INFOI:~IATiON HA,.~ REEN PROVIDED. <br /> <br />'rANK & DRAINP'IELD REPAIR R~6493 <br /> <br />JURiSDiCI'ION: BY gATE <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 REV, <br /> <br /> <br />