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MARION COUNTY BUILDING INSPECTION <br />SENATORBLDG 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 />DATE: ~"~'~¢g=/~"Z ~,n TIME: <br /> <br /> JACKSON. JOE B. & ~ZLDREO <br /> <br />$1fU3 ADDRESS <br /> <br /> 8801 HOMQUIST RD SE <br />,AU~V ]: LLE OR 97325 <br /> <br />808 SLATER <br />PO BOX 477 AUMSVILLE <br />PHONE; 749-1760 <br /> <br />LOT BLOCK <br />W,DrH 272 D~PT~ <br /> <br /> 31 <br /> <br />]0C AR6~ 27200.0 UN,TS <br /> <br /> TAX LOT CATEGORY RESI DENT~,~L <br />MARION COUNTY NO <br /> <br /> SITE NUM3ER: 4284 <br /> VALUATION: <br /> <br />8S 1W AR 48 <br />SF I~EG LOT NO co,~ <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />¢E~qVlIT OR APPLICATION NO: 9] 18 <br /> <br />CONTRACTOR, NO. <br />JACKSON, JOE B. & MILDRED <br />808 SLATER <br />PO 8OX 4?? AUMSVILLE 9?325 <br />PHONE: <br /> <br />WATER SUPPLYz PIA[ <br />TEST HOLES READY~ <br />SITE EVALUATION NUMBER: <br />EX~STING TANK SIZE: <br />EXISTING DRAIN F~ELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO- BEDROOMS: <br /> <br /> ITEM QUANT I TY AMOUNT <br /> REPAIR 1 $35,00 <br /> <br /> TOTAL ASSESSED FEES $35_ ,% <br /> PREVIOUS RECEIPTS $35,00 <br /> THIS RECEIPT $0 CO <br /> <br /> BALANCE DUE $0 ,, 00 <br /> <br />PAYEE; RECEIPT NO: <br />RECEIVED BY+` d~ TYPE: CHECK ~:: <br /> <br />~EE A,TACME0 DOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br />~< THIS IS A VALID PERMIT ~< THIS PERMIT EXPIRES 360 DAY~ FROM ITS ID,~UE DATE. IF <br />CX]N~TRUCTION FAIbS TO MEET ALL REQUIRID~ENT$ OF ~TATE LA~ AND MARION COUNTY BUILDING AND <br />ZONING ORDINANCES, THIS PERMIT SHALL BECOME NULL AND VOID_ <br /> <br />REMARKS: REPAIR R~9854 <br />DONAI_D E- WOOOLEY, MARION COUNTY ~UILDING OFFICIAL / BY .......... ~ ............. <br /> <br /> <br />