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MARION COUNTY <br /> t') UILDIN(; INSPECTION <br />Senator Building ,, 220 High Street NE · S~cond Floor * Salem, Oregon 97301-3670 <br /> <br /> Office Hours: 8:110 - 4:3(} Phone: 588-5147 Code-A-Phone: 4:30 p.m. - 8:00 a,m. <br /> <br />DATE: 12/12/88 TIME: ll:3g:52a <br /> <br /> ~VtARTIN, KIM ~THEN, 6XECUTOR <br /> <br />RESIDENTIAL <br /> <br /> 11848 DOCK INN RD <br />GERVAIS OR 97026 <br /> <br />~RION ~JNTY NO <br /> <br />5 <br /> <br />SAME <br /> <br />PHONE <br /> <br />SITE NUMBER: 61"/$ <br />VALUAT ION: <br /> <br /> 35 5S 2N EFU <br />12.8300 AC NO NO <br /> <br />18 <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PE~IT OR APPLICATION NOs 9012991 <br /> <br />CONTRACTOR, NO. <br />I~,RTIN, KIM MATHEN, EXECUTOR <br /> <br />PHONE: <br /> <br /> ITEM <br />[EXISTING SY~TElvt riVAL, RPT <br /> <br />~ATER,~JPPLY= P~ <br />TEST HOLES P, EADY= <br />SITE EVALUATION NUMBER: <br />EXISTING T~N~K SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: 7-15-B~ <br />PREVIOUS NO. BEDROOMS: <br /> <br />TOTAL AE~SEE~ED FEES <br />PRvEVIOU~ RECEIPTS <br />THI~ RECEIPT <br /> <br />~ANTITY A/~OUNT <br /> 1 $100~00 <br /> <br />$100.00 <br /> $o.oo <br />$100.00 <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: MART~IN, KIM MATHS, EXECUTOR RECEIPT NO: 13781 <br />RECEIVED BY. cl .... TYPE: CK CHECK ~: 210 <br />SEE ATTACHED DOCUMENT FOR REQUIREMFJqTS OF ON-SITE 3ENAGE SYSTEM. <br /> <br />* THIS IS NOT A PEr, lIT. THIS APPLICATION MUST GO THROUGH A REVlE~ PROCESS ~I-tERE THE <br />FOLI_O~ING MUST BE COMPLETED. IT IS THE RE3PON~IBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORMATION HAS BEEN PROVIDED. <br /> <br />DATE <br /> <br /> <br />