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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> COD~:-A~PHONE4::30 PM -8::0DAM, <br /> <br />I sm performing work on a properb/ I own or occupy, ~'~//S/~,,'F) ,, <br /> <br /> DATE: 10/2!/88 ...... ~IH~.: lt:2'1:58~ <br />iOWNER <br /> KROHN, MARLONE <br />!Si~US ADDRESS .............. <br /> <br /> 8914 SHA~ SOUA.RE RD SE <br /> AU~ISVZLLE <br /> <br /> SAME <br /> <br /> PHONE; 749-2721 <br /> <br />rk~'lE)~F N;: iDEPTH <br /> <br /> RESI DEN~IlAL <br /> ; CONSTRUCTION TY~E .................. <br /> <br />OR 97325 '~(}~ ~if~ iL~G~ ' ~ OOCUPAN~ LOAO <br /> <br /> SZTE NUMBER: 5826 <br /> VALUATION: <br />SECf~O~ TOWNSHIP ................. RANGE T~O~E .... <br /> <br /> 2.00000 AC NO : NO <br /> <br />TYPE: ON-SITE SENAGE <br /> <br />PERMIT OR APPLICATION NO: 9012038 <br /> <br />CONTRACTOR, NO. <br />KROHN, HARLONE <br />SAME <br /> <br />PHONE: 749-2721 <br /> <br />MATER SUPPLY: <br />TEST HOLES READY: <br />SiTE EVALUATION NUMBER: <br />EXISTING TANK SIZe: <br />EXISTING DRAIN FIELD L[NE$: <br />SEPTIC TANK PUNPEB: ~L~"~k¢~' <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM QUANTITY AMOUNT <br />ANNUAL EVAL_ ~ TEMP OR HOSHP MH 1 $80.00 <br /> <br /> TOTAL ASSESSEO FEES $80.00 <br /> PREVIOUS RECEIPTS $0.00 <br /> 'THIS RECEIPT $80.00 <br /> <br /> BAL.&HOE DUE $0.00 <br /> <br />PAYEE; KROHN, MARLOWE RECEIPT NO= ~2784 <br />RECEIVED BY: c~ I'YPE: OK CHECK ~: 834 <br /> <br />SEE ATT4£HEO DOCUMENT FOR REQUZRENENTS OF ON-S~TE SENAGE SYSTEf~. <br /> <br />* THZS IS NOT A PERM2T. THIS APPLZCAT~ON MUST GO THROU6~I A REV~EN PRO~F_~ NHERIE THE <br />FOLLOWING MUST BE COMPLETED. ZT ZS THE RESF~ZB~LZTY OF THE APPLZCANT TO ASSURE THAT <br />ALL NECESSARY INFOR~TZON HAS BEEN PROV~DEB. <br /> <br />REMARKS: ~IH HARDSHIP AUTH R~5630 <br /> <br />CITY JURISDICTION: BY <br /> <br />DATE .......... <br /> <br />FO~ ~ MC 1 sss n~v ~,~, OF FICE COPY <br /> <br /> <br />