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MARION COUNTY
<br /> BUILDING INSPECTION
<br />Sertator Building * 220 High Street N~. · Sc¢ood Floor · Salem. Oregon 97301-3670
<br />Office Hours: 8:00- 4:30 Phone: 588-5 I47 Code-A-Phone; 4;30 pall, - g:00 a.m.
<br />
<br />F_)AT;:: ,J,q./, ~,/,~, ~
<br /> KIRK, DOUG
<br />
<br />TiNE: 2:08:15p
<br />
<br /> 205 FRONT
<br />DS-~'RO,~ 'r-
<br />
<br />ND
<br />
<br />RO BDX 4!S
<br />
<br />PHONE: 854-~664
<br />
<br /> HAMMOND ADDN
<br />
<br />SITE NU~R: 51~6
<br /> VALUATION:
<br />
<br />$/? ',
<br />
<br />NO
<br />
<br />NO
<br />
<br />, YP~,,: ON-SITE
<br />
<br />P:_R?qlT OR ACPLICATZON N,,,: ! 0298
<br />
<br />CONTRACTOR, NO.
<br />K,[R~q, DOUG
<br />PO BOX ~ ! 8
<br />,_'JE :~(;) :1 '~' 97342
<br />PHONE: 854-,-3664
<br />
<br />~ATER SUPPLY: CN
<br />TEST HOLES READY:
<br />SITE EVALUATION NUMBER:
<br />EXISTING TANK SIZff: 750
<br />EXISTING DRAIN FIELD LINES:
<br />SEPTIC TANK PUMPED: 7/5/88
<br />PREVIOUS NO. BEDROOMS:
<br />
<br />~TEM QUANTITY AMOUNT
<br />
<br />EX:,=~ IN,,= SYSTEM E'VAL, RPT.
<br />
<br />:OTA~ ASSESSED FEES
<br />PR~IOUS RECEIPTS
<br />THIS
<br />
<br />BALANCE DUE
<br />
<br />/>AYEE: :NV'CICE NO:
<br />RE~TV,~ CL , g~,, CI"ECK ~;:
<br />
<br />$!00_00
<br />
<br /> 100_00
<br /> 100.00
<br /> $0.00
<br />
<br /> $0.00
<br />
<br />.......... ~_w.G,,. SYSTEf',(.
<br />S~'ATTACHED DOCUMENT FOR REQUIREMENTS OF ON....SiTE =;"'~'=:
<br />
<br />* THIS IS A VALID PEPJ~IIT * THIS PER~4IT EXPIRES 380 DAYS FROM ITS IS,SUE DATE. IF
<br />CONSTRUCTION FAILS TO MEB'T ALL REQUIREMENTS OF STATE LAMS AND MARION COUNTY ~UILDING AND
<br />ZONING ORDINANCES, THIS PERMIT SHALL BECOME NULL AND VOID,
<br />
<br />r<_MARKo: _.X I,~, ~ ~, I~,~, DY.mT-N, EVAL FDR LOAN R~4.4 '; 5:
<br />
<br />_I(..,,~AL__,., E, ¢&A_,OL.A::.. , ,v!AR~CN ~,O,-,N,Y ¢'%.,.L,.,.NG '.)F'F'.*C~,AL / BY
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