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MARION COUNTRY BUJLDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:3,0 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> 14717 A~ ~ NAY <br /> OR 9?002 t <br /> <br />~ A~E~ CREST ADDJT[~ <br /> ~E: 266-213~ ~ SiTE NU~ER: 92-020'I4 <br /> <br />, , , <br />; 99 149 GF Y~ NO <br /> <br />TYPE: <br /> <br />PERMIT OR APPL[CA'rION NO: 9040243 <br /> <br />OONTRACTOR, NO. <br />O~BRIEN, C~ARL~S <br /> 10155 5. MAC~URG <br />? <br /> PHONE: 266-2139 <br /> <br />~.TERECJPPLY: CN <br />TEST HOLE~ READY: <br />SiTE EYALUATiON NUMBER= <br />P_XiSTiNE TANK SIZE: <br />EXiSTiNG DRAIN FIELD LINES: <br />SEPT'kC TANK PUMPED~ <br />PREViOU~ NO_ BEDROOMS: <br /> <br /> ITEM <br />STANDARD ON-Si'rE SY'S'rEr,1 <br /> <br />~JANT i'I'Y 1 <br /> <br />TO~ALASS~ED FEES <br />RREVI~US RECEIPTS <br />THiS RECEIPT <br /> <br /> BALANCE DUE <br /> <br />PAYEE: O'BR[~. CHARLEG i ~., iNVOICE NO: <br />RECEIVED BY'- P8 TYPE; IN <br /> <br />SEE A'rTA~EO ~M~T FOR ~[~TS OF' <br /> <br />$210.00 <br /> <br />$2t0.00 <br /> $o.oo <br />$210.00 <br /> <br /> $0.00 <br /> 0 <br /> <br /> * THIS I$ NOT A PEI~IIT. THI~ APPLICATiON;'IqJST ~O THROUGH A REVIET~ PROCI~$~ ~"IERE THE <br />I=OLL0~IIN~ I~UST BE COI~PLE'fED. : iT' I.~ ,THE', RE~°OD~i~II. ITY OF THE APPLICANT TO ~RE THAT <br />ALL NECESE~RY INFOR~IATION HA~,BEEN PROVIDED. <br /> <br />NEW SEPTIC <br /> <br />CITY JURISDiCTiC~: 8Y .................. DATE ............................ <br /> <br />OFFICECOPY <br /> <br /> <br />