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MARION COUNTY BUILDING INSPECTION <br />SENATOR 8LOG, 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 />OATE:..:IO/21/_q 1. 1' IM~.: 12-:06;68 <br /> K~TA, P~RL <br /> <br />RESJD~N1. <br /> <br /> 10791ARNOT ROAD NE <br /> AURORA OR 97002 <br /> <br />LJ~EF~UICEI~G .................................... <br /> <br />MAI'LING ADDRESS: ....... S~eD~I$1ON: ' <br /> <br /> VALMAT Z ~: <br /> <br /> ]2~ ]20 ]AA00. . ~ ~ <br /> <br /> MAP: <br /> <br /> 1 <br /> <br />NO ~_ NO <br /> <br />~YPE: ON-SITE 5ENAGE <br /> <br />PERMi'F OR APPLICATION NO: <br /> <br />C_,Of4'I'~CTOR, NO. <br />KOCS'rA, PEARL <br /> <br />678-5965 <br /> <br />9036242 <br /> <br />WATER SUPPLY: PN <br />'TEST HOLES READY; <br />SiTE 6¥ALUATi0¢4 NUMBER: <br />EXISTING TANK SIZE; <br />EXI~TiN6 ORA. iN ~IEkD LINES: <br />SaP'rlc TANK PO~PEO: <br />PREVIGO5 NO. BEDROO¢4~: <br /> <br /> I l PJ~I QUANT 1'1¥ APfOUN T <br /> AU'FHORi ZA'r i ON NOT iCE -,- FLO. Vlsi 'r 1 $ ] 1 o. Do <br /> <br /> PR~I~S RECEIPTS $0.00 <br /> THIS RECEIPT $110,00 <br /> ~ eA~c~ ~ ~ ~ $o.oo <br /> PAYE~; P~RL K~'TA ~ ~ Rb~P]' NO: . ~ 3815~ <br /> <br /> Sa~ A'r'FA~ED ~M~'r FOR RE~IR~TS OF ~-S]T6 Sa~Aea S~T~_ ~ ~, <br /> <br /> THIS IS NOT A PEBiT. THIS APPLI~Ti~ ~T ~:TH~ A R~I~ P~ ~ERE T <br />~LL~I~ ~ST BE ~PL~ED.: ]T 1S THE :R~SIBILITy~V'OF ~E APPLI~T TO ~RE THAT <br /> <br />ALL N~RY INFOI:~tATION HAS BEENPROVIOEO. <br /> <br />PLAN REVIaW: aY ............... DATE ............. <br /> <br />REMARKS: AUTH - FIELD VlEil' R't13774 <br /> <br />OFFICE COPY <br /> <br />Ci~'Y JURISDICTION: BY ................ OATE ................. <br /> <br /> <br />