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MARION COUNTY <br /> BUILDING INSPFCTION <br /> <br />OATE: 03/28/89 TIME: 4;31:26p <br /> <br /> JENSEN, DALLAS <br /> <br />RESIDENTIAL <br /> <br /> 9223 9233 W STA~FON RD <br />AUMSVILLE OR <br /> <br />9?325 <br /> <br />SE <br /> <br />MARION COUNTY NO <br /> <br />SANE <br /> <br />PHONE: 749-1089 <br /> <br />SITE NUMBER; 6622 <br />VALUATION: <br /> <br />TYPE: ON-SITE SENAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR. NO. <br />J ENSEN, DALLAS <br />SAME <br /> <br />PHONE= 749-1089 <br /> <br /> I gs 2W EFU <br />2.81000 AC NO NO <br /> <br />14205 <br /> <br />MATER SUPPLY: F'N <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: 1000 <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: GIVEN FORM <br />PREVIOUS NO. BEDROOMS: <br /> <br />82 <br /> <br /> ITEM <br />ANNUAL EVAL. - TEMP OR HDSHP NH <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANTITY AMOUNT <br /> $6O,OO <br /> <br />$60.00 <br />$60_00 <br /> $o.oo <br /> <br />BALANCE DUE $0.00 <br /> <br />RECEIPT NO: <br />CHECK <br /> <br />PAYEE: <br />RECEIVED BY: c] TYPE: <br /> <br />SEE ATTACHED DOCUMENT FOR REQUIREMENTS OF ON-SITE SENAGE SYSTEM. <br /> <br />* THIS IS A VALID PERMIT * THIS PERMIT EY, PIRES 360 DAY~ FROM ITS I$~JE DATE. IF <br />CONSTRUCTION FAILS TO MEET ALL RE(~UIREMENT~ OF STATE LA~ANDMARION COUNTY BUILDING AND <br />ZONING ORDINANCES, THIS PERMIT SHALL BECOME NULL AND VOID. <br /> <br />REMARKS: HDSP AUTH ~ <br />OONALD E. NOODLEY, MARION COUNTY BUILDING OFFICIAL / BY ......................__~.____ <br /> <br /> <br />