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LULAY, ANDRIAN <br /> <br />MARION COUNTY BUiLDiNG iNSPECTiON <br />SENATOR BLDG. NO, 225 <br />,220 HIGH STREET NE <br /> SALEM, OREGON 97801 <br /> <br /> PHONE '588-5147 <br /> <br /> REST DENT ~ AL <br /> <br /> ~002 SHAFF RD SE <br /> ~ CONTRAOT C~TY; ~ UGh; ~OCC~pANT LOAD: <br />.A.UNSVI LLE OR 97325 ; , , <br /> <br />!0981SHAFF R0 SE <br />AU~SVILLE OR 9?325 <br />PHGNE; 789¢5388 <br /> <br />TYPE; ON~S~TE SENAGE <br /> <br />PERN~T OR APPLICATION NO: <br /> <br />CONTRACTOR, NO, <br />LULAY, ANDRZAN <br />i098'1 SNAFF RD SE <br />AUNSVILL. E OR 8?325 <br />PHONE~ 78B~5388 <br /> <br /> SITE NUMBER~ 3584 <br /> VALUATION: <br /> <br /> 08 ~S [ !~ EFU <br /> <br /> NATER SU~PLY~ PN <br /> T~T NOLES <br />9008485 SITE EVALUATION NUNSER: <br /> EXISTING TANK SIZE: <br /> EXISTING DRAIN FIELD LINES: <br /> SEPTIC TANK PUMPED: NILL 8RING IN <br /> PREVIOUS NO. ~EDROOMS: <br /> <br /> I TEN ~Td AN T I TY AMOUN*' <br />AUTHORIZATION NOTICE - FLD, ¢ISIT 1 $55,00 <br /> ~g TOTAL ASSESSED =E~S $65.00 <br /> THIS RECEIPT $65.0O <br /> ~ BAL~CE DUE $0,00 <br /> <br />PAYEE: LULAY ANDRIA~ ~' =, RECEIPT NO: <br />REC~VE0 BY: mb ~_~j . T,~P6~ CK: CH6CK ~: O <br /> <br />~ ~[S IS NOT A PE~[T. ~IS ,A~LICATI~ ~T ~ ~ A ~I~ P~ ~6RE ~6 <br />FO~IN~ ~ST 8E ~LCEB. IT I8 ~E'" E~IeIL~ OF '~E ~PLIC~T TO ~RE ~AT <br />ALL NEC(~Y [NFO~T[~ ~ <br /> <br />CLAN REVI~: BY__~____ DATE ............ CITY JURISDICTION: B%~ ....... DATE <br />RE~ARKS: <br /> <br />OFFICE COPY <br /> <br /> <br />