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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 8::00 - 4::30 <br /> · 24 HOUR CODE-A-PHONE:: 588-7904 ~ ~- <br />Jloi'~ r~iji~'fs~i~?~ieg, bd~lbllCiikedr,C~r ~)~r~P~rtl~818u~,c¢fl~o,*iz~J('ruoP, o~,osor~tah,o SIGNATUF~E OF APPI IC~NT~ <br /> <br />SITUS ^DOnF~RCK)~' DALLA~ <br /> <br /> 5035 HONELL PRAIRIE ROAO <br /> AUFiSV 1LL~- OR 9732,5 <br />USE OF BUILDING <br /> <br />SE <br /> <br />MARION COUN I Y NO <br /> <br />3 <br /> <br />RESiDENtiAL <br /> <br />LOT <br /> <br />BLOCK SbCTION TOWNSHIP <br /> <br />SITE NUMBER: <br />.~N~LUA r ION: <br /> <br />NO <br /> <br />1 19'12 <br /> MAP <br /> <br />NO <br /> <br />PEP,~iF OR APPLICAtiON NO: 9029436 <br /> <br />IURNER OR 97392 <br />PHONE: 743-2343 <br /> <br />lES1HOL~ READY: <br />3iFE EVALUAfIION NUMBER: <br /> <br />ES<ISliNG ORAIN FIELD LINE~: <br />SEPIIC lANK PUMPED: <br />PREWiOUS NO. 8EOROOM5= <br /> <br /> IfEM ',0UANJlfY AJ~4OUN~ <br /> REPAIR ~ f~,JOR 1 $80.00 <br /> fOfAL ASSESSED FEES $80.00 <br /> PRE~/iOU~ RECEiPFS $0.00 <br /> ~HIS RECEiP! $80.00 <br /> <br /> BALANCE BUE $0.00 <br /> PAYEE: r.:..'I~!A[N BEfHEL & ~5ONS l~(C RECE~P~ NO: 3~096 <br /> RECE[VED BY: OM2 tYPE: CK CHECK ~= 4248 <br /> <br /> SEE AIfACHED DOCUMEN[' FOR RE(;~UiREJ~IENTS OF ON-SiTE SEWAGE SYSTEM. <br /> <br />~ THIS IS NOT A PER,lIT. THIS APPLICATioN rflUST GO fHROUEH A RETv'IB ~ROCE3S [,,HERE THE <br />POLLONiNG iviJST BE COIVlPLETED. IT IS THE RESPONSIBILITY OF THE APPLICANT TO ~RE THAT <br />ALL NEC~RY INFOI~t. TiON HAS BEEN PROVIDED+ <br /> <br />REMARKS: DRAiINFIELD REPAIR ONLy R:~4799 <br /> <br />DAtE <br /> <br />OFF~CE COPY <br /> <br /> <br />