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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLI~G, NO, 225 <br />220 H~GH STREE"f NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 888-7904 <br /> <br />Other <br /> <br />I have read 8nd agree lo the [erms 8rated o1~ the revecse side of <br /> <br />SIGNATURE OF APPLICANT; <br /> <br /> OATE: <br /> <br />OWN~,f,£: 08129/91 Ti~4E= 11:10:08 <br />S~TUS ADOREss~PPEF~, MARGARET <br /> <br />20057 GRIM RD <br /> <br />MAILING ADDRESS: <br /> <br />0R--.9~002 <br /> <br />LOT: <br /> <br />18381BOONES FERRY RD NE <br />HUBBARD, OR 9?032 <br />PHONE: 981-8873 <br /> <br />DEC'TH: <br /> <br /> ; TAX LOT'. :CATEGORY: <br /> <br /> [ CONTRACT blTg: ! [J~: [OCCUPANT LOAD: <br />NE ' <br /> <br /> NO. OF 8EOR00MS: <br /> MARiON COUNI'Y NO <br /> <br /> ; SUBDIWSION: <br /> <br />'IYPE: ON-S,[TE SE~,iAGE <br /> <br />PERMIT OR APPLICAT,[ON NO: 31040 <br /> <br />E~N'FRAC'FOR, NO. 34535 <br />ARERiCAN UNDER6ROUND CONST. <br />PO EOX 557 <br />MOLALLA, OREGON 97038 <br />PHONE: 829-9407 <br /> <br />WATER .Et`[PPLY: PW <br />TEST HOLE,*S RFJ~DY~ <br />SiTE EYALUATiON NUr, lJgER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINE~: <br />SEPTIC TANK PUffiPED: <br />PRE¥IOUS NO. BEDRCX]v~: <br /> <br /> Il'EM <br />REPAIR ~ MAJOR <br /> <br />QUANTITY At, fJUNI' <br /> 1 $80~00 <br /> <br />TOTAL ASE,~ED FEES <br />PREVICUSRE~E[P'TS <br />THiS RECEIPT <br /> <br />~80.00 <br /> 80.00 <br /> $0,00 <br /> <br />8ALJ~NCE DUE $0.00 <br /> <br />PAYEE: RECEIPT NO: <br />RECEIVED BY: CL TYPE: CHECK <br /> <br />588 ATTACHED DEX;1.~ENT FOR :REQUZREI~ENTS OF ~-SITE ~E SYST~+ <br /> <br />~ TH[~ 1S A V~JD P~IT ~ ~IS P~IT ~1~ ~60 ~ ~ 1~ I~E <br /> <br />CONSTRUCTiON FAiL~ TO MEET ALL RI~XJI. RE~E~T~ OF STATE'UVA~ AND iN4ARiON COUNTY 8UILDING AND <br />ZONIN~ ORDINANCES, TH/S PEI~IIT EfrlALL BECONIE NULL AND VOID+ <br /> <br />RET~ARKS: MAJOR REPAIR R~7290 A~ <br />DONALD E. NOODLEY, r~RiON 6OUNI'¥DUiLDiN~OFFICIAL/ BY, .......................................................................~, <br /> <br />Fon~, ~c ~s-~ ~v. ~/~ OF FICE COPY <br /> <br /> <br />