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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 <br />CODE-A-PHONE 4:30 P.M, - 8:00 A,M. <br /> <br />I am performing work or~ a property I own or occupy· <br />I am a registered builder OR the authorized representative <br /> of a registered buUder. <br />'the work will be performed by a registered builder, <br />Other <br /> <br />[)ATE: 11/20/87 TIMEr !l:42tS4a <br /> <br /> BUTLER, GEORGE L. & EDNA <br /> <br />[ C0N~RtJbTIEN TYP'~: ! OCCUPANCY <br /> <br /> 87,21 LITTLE RD SE '~8~i'~,'c'~8n:¥; ..... <br /> · U,,~-.V ...... OR 973~5 ~ <br /> M~RI~ COUNTY <br /> <br /> '~ ~459 STAYTON RD SE <br /> STAYTON, OR 9?383 <br /> ~HONE: 769"'5503 i SITE NUMBER: 3033 <br /> ~ VALUATION <br />LOT: 8LOOK: ~$~OTi0~; [ ~i'~ ~r RANGK: ,' 'g0~E: MAp; <br /> <br /> ' ' 36 J 8S : 2W <br /> <br /> ss.00oc ¢ AC <br /> <br />TYPE: ON-SITE SENAGE <br /> <br />PERNIT GR APPLICATION NO: 540? <br /> <br />CONTRACTOR, NO. <br />8LITLER, GEORGE L. & EDNA M. <br />11~$9 STAYTQN RD SE <br />STAYTON, OR 9?383 <br />PHONE: 769~5503 <br /> <br />WATER SUPPLY; PN <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING 0~A;N FIELD LINES= <br />SEPTIC TANK PUMPED: 9~27,~95 <br />PREVIOUS NO. 8EDROOMS: 3 <br /> <br /> i TEM QUANT I TY AMOUNT <br />~LjTHORIZ, ATION NOTICr_' - FLD_ VISIT 1 <br /> <br /> : :TOZAL. A~E~ FEES $65.08 <br /> PREVIODS RECEIPTS $85. <br /> ,~;) ~HIS RECEIPT ' $O-0O <br /> :'¢,aAL~CE ,~E :: $0_ 09 <br />PAYEE; :;: ':~ ;: ~ECEZPT <br />RECEIVE0 8Yt DB , '," TYPE:' CHECK ~: <br /> <br />,~c,~,, A r [AC,qE0 DOCUMENT FOR ~E,,:S~GE :~YS~EH, <br />............................... ~ ..... ~ '~%~~~--~----~ <br />~ ~s zs ~ VALZS PE~T ~ ITS Z~E DATE. <br />Z~ING OROI~C~. ~IS [~a~ ~tD2 <br /> <br />REMARKS ~ AUTH .NOT 1"CE R=E 1~2 ' <br /> <br />OCNAL. D E. WOODLEY, MARION COUNTY BUILBING OFEZC'.rAL / BY <br /> <br />F/I~M ,, MC. 15'~6 HFV ~V~ OFFICE COPY <br /> <br /> <br />