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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-:,3O P,M, - 8:00 A,M. <br /> <br />Of her <br /> <br />I have read and agree to the ret'ms stated or~ the roverse side of <br /> <br />NICHOL, DoUG~& NIAUn~TA <br /> <br />8489 MILL CREEK RD <br /> <br />SE <br /> <br />RES I' BENT 1' AL <br /> <br /> 924 NORTH DOUGLAS <br /> STAYTON, OR 97383 <br /> PHONE= 769~7248 <br /> <br />~-oT: iSLSCK: <br /> <br /> SITE NUN~ER: 5497 <br /> VALUATION: <br /> <br />31. go00 ' AC N0 NO <br /> <br />TYPE= ON-SITE SENAGE <br /> <br />PERNIT OR APPLICATION NO= 111~3 <br /> <br />CONTRACTOR, NO. <br />NICHOL, DOUGLAS. & MAURITA <br />924 NORTH DOUGLAS <br />STAYTON, OR 9?333 <br />PHONE: 769-7248 <br /> <br />HATER SUPPLY: PN <br />TE~T HOLES I:~EADY: YE~ <br />SITE EVALUATION NU~ER: <br />EXIST1'NG TANK SIZE. <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIC~JS NO. BEDRO~: <br /> <br /> ITEN <br />SITE EVALUATION, FIF~T LOT <br /> <br />qUANTITY A~OUNT <br /> $175.00 <br /> <br /> TOTAL ASSESSED' :FEES $17 $. 00 <br /> .- .' ,,~f~,[( PREVIOUS RECEIPTS: $17~. O0 <br /> <br />PAYEE = R~EZPT <br /> <br /> NOT On <br /> <br />~E~RKS: SE ~4854 D E N Z E D <br />~ALD E, N~DLEY, HARMON ~"TY BUILD~NG "OFFICiAE / BY .... ~ <br /> . : , <br /> <br />~or~M ,¢ Mc ~.5~ ~v e/87 OFFICE COPY <br /> <br /> <br />