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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO 225 <br />2,,20 IIIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE:: 588-5147 8;;00 - 4:30 <br />24 HOUR CODE-A-PHONE;: $88-7904 <br /> <br />~IGNATURE OF APPLICANT <br /> D&TE <br /> <br /> OAfE¢ 01/03/91 TIME: <br />OWNER TAX LOT C~TEGO;~¥ <br /> MARC'KY, OALLA5 <br /> <br />Rb.,,~ I t)bN l i~L <br /> <br /> 5035 HOWELL PRAiRiE ROAD <br />AUM~VI L-Lb OR 9 . 325 <br /> <br />~ARi ON COUN ] Y NO <br /> <br />PHONE: 5i ~E NUIVfB~.R: 1 1 9?2 <br /> VALUA F i ON: <br /> <br /> '1:3 85 2W GPU <br /> NO NO <br /> <br />TYPE' ON--SirE SEWAGE <br /> <br />PgR~if OR APPLiCAfi©N NO= 29438 <br /> <br />CONfP, ACfOR, NO. 44551 <br />DWAIN 8ETHEL & SONS ~XC <br />P.O_ 80X 504 <br />tURNER UR 9?392 <br />PHONE: <br /> <br />WAFER SUPPLY: PW <br />lESt HOLE~ READY: <br />SITE gYALUAFiON Nurv~ER$ <br />EXiSi~N6 TANK SIZE: <br />~,×ISflNG ORAiN ~IELD <br />SEPtiC lANK PUMPED: <br />PReViOUS NO_ <br /> <br />i'IEM QUANIiIY AMOUNJ <br />REPAIR - MAJOR 1 $80,00 <br /> <br />fOIAL ~ES~ED PgE5 <br />PRg¥iOUS RECEZPFS <br />fHi5 RECEIPT <br /> <br />BALANCE DUE <br /> <br />$80.00 <br />$80_00 <br /> $o.oo <br /> <br />$0.00 <br /> <br /> PAYEE- RECEiPt NOt <br /> RECEIVED BY' c'l tYPE: CHECK ~: 0 <br /> SEE AfIACHED DOCUMENT FOR REQUIREMENTS OF ON-S~'fE <br /> <br />~ 'IHI8 15 A VAL~O PER,liT * THiS PERM~'f' EXPIRES 360 DAYS FF.~f4 iTS iSSUE DATE. IF <br />CONSTRUCTION FAIL.S TO ~EBT ALL REdIReCTS OF STATE <br />Z~1N60RDIN~C~S, THi~ PE~iT ~ALL BEdE NULL ~D <br /> <br />REMARKS: DRAiNPiELD REPAIR ONLY R~4799 <br />DONALD E. WOODLEY, 114AR[OF,I COUNIY BUiLDiNG OPPIC[AL / BY ~. <br /> <br />~OnM ~ MC *SS6*~'~ '~0 OFFICE COPY <br /> <br /> <br />