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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 />The work will be per/ormed by a registered builder. <br /> <br />DATE: I2/01/74 TIME: 10:0,5=4~ <br /> RESISENTIAL <br /> CONSTRUCTION TYPE: OCCuPAN'~: <br /> <br />97325 <br /> <br /> 8983 W STAYTON RD <br />AUMSVILLE OR <br /> <br />SANE ! .............. <br /> SITE NUHBER~ 94-~4519 <br />PHONE: 749-2214 ! VALUATION: <br /> <br />NO. OF BEDROOMS <br /> <br />RANGE'. i MAP: <br /> <br />TYPE= OH-SITE <br /> <br />PERNIT OR APPLICATION <br /> <br />CONTRACTOR~ NO. <br />COQK~ ARNOLD <br />SANE <br /> <br />PHONE: 749-2214 <br /> <br />9859968 <br /> <br />WATER SUPPLY <br />TEST HOLE9 READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING BRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM QUANTITY AMOUNT <br /> ANNUAL EVAL.. - TEMP OR 'HDSHP MH 1 $90,00 <br /> <br /> TOTAL A~SESSED FEES $90.80 <br /> PREVIOUS RECEIPTS ~., I' $0,00 <br /> <br /> PAYEE: COOK~ ARNOLD - ~ran$ from, plan~ing RECEIPT NO: 6256;~ <br /> RECEIVED BY. cl TYPE: in CHECK $: 8 <br /> SEE ATTACHED DOCUMENT FOR EEQIJZREMENTS OF ON-SITE SEWAGE SYSTEH. <br /> <br /> * THIS IS NOT A PEENIT. ~HIS, APPLI~ATIO~.,NU~] ,~ ~HROUAH A REVIEW PROCESS W~ERE THE <br />FOLLOWING HUST BE COMPLETED.' 'IT l,S THE. E~SPONo~'BIL, ITY O~ THE APPLICANT TO AS,)URE THAT <br />ALL NECESSARY INFORMATION HAS 'BEEN PROVIDED. ' : " <br /> <br /> PLAN REVIEW: BY ................. 9AT~ CITY JURISglCTION: BY ...................... DATE .............................. <br /> <br /> REMA~I(S: **,refund,* [{ ~ ~~,),~ ~ <br /> <br /> OFFICE COPY <br />FORM # MC 15-58 REV, 4/9o <br /> <br /> <br />