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MARION COUNTY <br /> I-it/ILDING [N'-,PE( TION <br /> <br />KEARNES, JOAN <br /> <br />RE~I DB~-IAL <br /> <br /> 8193 PARKER LANE <br />AIJ~SVI LLE OR 9?325 <br /> <br />NO <br /> <br />3 <br /> <br />378-9077 <br /> <br />SITE NUMBER: <br /> vAL/JATION: <br /> <br />6177 <br /> <br />NO <br /> <br />TYPE: <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO+ 34916P-2 <br />STAYTON MILL CITY $ILVERTON <br />~1155 STAYTON SCiO DRIVE, SE <br />STAYTON, OREG(~ 97383 <br />~HONE: 769-2302 ,,*. , <br /> <br /> ITEM <br />REPAIR - MAJOR <br /> <br />9012995 <br /> <br />t~ATERSUPPLY: P~ <br />TEST HOLES READY: <br />SITE EVALUATION NUN~ER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> QIJANTITY AMOUNT <br /> 1 $80.00 <br /> <br /> TOTAL AS.S~EO FEES $80.00 <br /> PREVIOUS RECEIPTS $0.00 <br /> THIS RECEIPT $80.00 <br /> <br /> BALANCE DUE $0.00 <br /> <br />PAYEE: STAY'TON MILL CITY SILVERTON SEPTIC RECEIPT NO: 13789 <br />RECEIVED BY: c] TYPE: CE CHECK ~: 10259 <br /> <br />SEE ATTACHED D(DCUMENT FOR RE~UIRE~IENT~ OF ON-SITE SEWAGE SYSTEM. <br /> <br />* THiS IS NOT A PERMIT. l~IS APPLICATION iVL~T GO THR~UEH A REVIEW/ PROCE~ hHERE ~HE <br />FOLLO~IN~ ~ BE C01~PLETED. iT IS THE RESPONSIBILITY OF THE APPLICANT TO A,SSURE THAT <br />AIL NECEE~ARY INFOR~ATIOR HA~ SEEN PROVIDED+ <br /> <br />PLAN REVIE!,q: 8Y_~~DATE, )~ cITY JURISDICTIONt 8Y <br />RB~,ARF~: DRAINF]FELD REPAIR R~5746 ' ~ <br /> <br />DATE <br /> <br /> <br />