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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 4:30 P.M, - 8:00 A,M, ~'~,...., .._~ <br />I am performir~9 work on a property I own or occupy. ~ <br /> <br /> / <br />I have read and agree to the terms stated on the reverse side of DATE: (~/~ .. -- 7 <br /> <br />ow~TE: 10/12/89 TIME: 11:17:33a TAXLOT: CAYSGORY: <br /> sENE*C, STEVE <br /> <br />RESIDENTIAL <br /> <br />7243 SHAW H~CY SE CONTRACT CITY: U~B: <br />AU~SV I LLE OR 9'/325 <br /> Iv~RION COUNTY NO <br />USE QF BUILDING: <br /> <br />OCCUPANT LOAD: <br /> <br /> NC). OF BEDBOOMS <br /> <br /> 3 <br /> <br />P.O. BOX 290 / REX LUCAS <br />AUMSILLE, OR 97325 <br />~HONE: ?49-25?6 <br /> <br />LOT: BLOCK: SECTION: <br /> <br />WIDI'H: DEPTH: AREA: <br /> <br />8598 <br /> <br /> SITE NUMBER: <br /> VALUATION ~. <br /> TOWNSHIP: RANGE: ~ONE: MAP: <br /> <br /> 25 UN[TS: 9S ~RREG. LOT: 2W CORNER: RA 51 <br /> <br />1 . 80000 AC NO NO <br /> <br />TYPE: ON-SITE SEWAGE WATER SUPPLY: PN <br /> 9019564 TEST HOLES READY: <br />PERMIT OR APPLICATION NO; SITE EVALUATION NUMBER: <br /> EXISTING TANK SIZE: 1200 <br />CONTRACTOR, NO- 34055 C. Q¢,~J EXISTING DRAIN FIELD LINES: <br />EMERY & SONS CONSTRUCTION IN SEPTIC TANK PUMPED: 10-99 <br />BOX 398 ' (~-(~ PREVIOUS NO, 8EDROO~: <br /> ONE:STAYTON' ORE N 9. 3 ?75/ <br />ITEN OUANTZTY AMOUNT <br />REPAIR - MAJOR 1 $80_00 <br /> <br /> FOTAL A.5~ESSED FEES $80.00 <br /> PREVIOUS' RECEIPTS $0_00 <br /> THI~ RECEIPT $80.00 <br /> <br /> ¢ BALANCE'DUE $0.00 <br /> <br />PAYEE: LuCAS, REX RECEIPT NO: 20?60 <br />RECEIVED BY: c] ,T~PE":,CK CHECK ~: 435 <br /> <br /> FOR 0¢ O..SITE SEWAGE SYSTE . <br /> <br />FOLLOWING MUST BE COIflPLETED.. [T .IS THE RESPONSZBzE[TY OF ~rHE APPL[CC~T TO ASE~JRE THA <br />ALL NECE;SE~ARY INFOF~!ATION HAS..BEEN. PROVIDED;~ , <br /> <br />PLAN REVIEW: BY - 0A~E <br />REMARKS: D-BOX/ DRAINFIELB 'REPAIR '~7854 <br /> <br />CITY JURISDICTION: BY ........ OATE .......... <br /> <br />OFF]CE COPY <br /> <br /> <br />