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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 /> <br /> [)AIE: 01/08/91 Fi~IE: 15:48:44 <br />OWNER <br /> <br />TAX LOT CATEGORY <br /> 67644-814 <br /> <br />DEN [ ! AL <br /> <br /> 9292 ~1I CH RD SE <br />AUM~VI LLE OR 97325 <br /> <br />CONTRACT CITY UCB <br />MARioN r;OUN rY NO <br /> <br />OCCUPANT LOAO <br /> <br /> 3 <br /> <br /> P.O. 983 <br /> AU Vib S, OR <br /> PHf.)N~-: 370-4569 <br /> <br />LO f 8t. OCK 5ECl ION TOWN~N I P <br /> <br /> Sl'fE NUt4BER: 32059 <br /> VALUA r iON: <br /> <br /> RANGF ZONE <br /> <br />~ IRREG LOT NO OOHNE~O <br /> <br />MAP <br /> <br /> 51 <br /> <br />IYPE: ON~SI1E SEWAGE <br /> <br />PERMi1 OR APPLICAIlON NO: <br /> <br />OON~RACTOR, NO. <br />WILSON, MELVIN <br />P.O. 983 <br />AUMLSViLL~, OR <br />PHONE: 3'10-4569 <br /> <br />9029689 <br /> <br />WATER.~..IPPLY: PW <br />T~T HOLES READY: <br />$iIE EVALUATION NU~ER: <br />~iSrING TANK SIZE; <br />EXISTING DRAIN FIELD <br />SEP'~IC TANK F"U~PED: <br />PREVIOUS NO. BEDROOI~5: <br /> <br /> I T~J~I <br />AU1HORIZA'IiON NOIlCE - NO ViSII <br /> <br />PAYEE: NIL. S(~, JONN <br /> <br />TOTAL AE~ED FEE.~ <br />PREWIOUS RECEiPIS <br />THiS RECEIPT <br /> <br />qUANtiTY At~3JN'r <br /> 1 $8o.oo <br /> <br />$60,00 <br /> $o.oo <br />$60.00 <br /> <br />BALANCE DUE <br /> <br />RECEIPT NO: 31367 <br /> <br /> RECEIVED BY: CL TYPE= CK ONE~K ~: 306 <br /> <br /> SEE A1 IADHED DOCUMENT FOR RE~JIREI~PJNI'S OF ~-SITE SE~GE SYSTEM. <br /> <br />~ TH]~ I~ ~T A P~IT. TH]~ A~1~TI~ ~T ~ TH~ A R~I~ P~ ~6 TH~ <br />~L~ING ~T BE ~PLETED. IT 1S THE R~iBiLITY OF THE APPLIC~T TO ~ THAT <br />ALL N~ IN~TI~ H~ BE~ P~IDED. <br /> <br />REC4ARKS: SEPFiC SYSFEM NEWER PLACED iN USE, AUFH NO vtstr <br /> <br />FORM # MO 15-56REV 4,90 OFFICE COPY <br /> <br /> <br />