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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 OODE-A-PHONE: 588-7904 <br /> <br /> i &m performing work on a property I own or occupy, <br /> lam 8registered buitderOR( )theauthori~edrepresentative <br /> <br /> DATE: 08/~,~/73 TTME: ,t3:2¢:43 <br />ow~; JOMNSSN~ EARl. <br /> <br />SITUS ADDRESS: 60~STRUCTION TYPE; <br /> <br /> 8754 MILL CREEK RD <br />AUMSVILLE~ OREGON <br /> <br />SANE <br /> <br />OR 97325 i c~NCI~OUNTYi ue~o !occuP*NT LOAD: <br /> <br />PHONE:: 749-2601 <br /> <br />VALUATION: <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PER~IT OR APPLICATION NO: <br /> <br />CONTRACTOR,. ,NO. <br />,JOHNSON~ EARL <br />SAME <br /> <br />PHONE: 747-2601 <br /> <br />47798 <br /> <br />WATER SUPPLY <br />TEST HOLES REABY: <br />SITE EVALUATION NUMBER:: <br />EXISTING TANK SIZE: <br />EXISTING BRAIN FIELD LINES: <br />SE?TIC TANK PUMPEb: 8/5/9~ <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM QIJANTITY AMOUNT <br />ANNUAL EVAL. - TEMP OR HDSHP ~H 1 $90.00 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />$90,.00 <br />$90.~ <br /> <br />BALANCE DOE $0.00 <br /> <br />PAYEE: RECEIPT NO: <br /> <br /> RECEIVED BY: PB ....................................... TYFE. CHECK ~,: 0 <br /> <br /> SEE ATTACHED DOCUMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br /> ~ THIS IS A VALID PERMIT ~ THIS PEAr, IT EXPIRES ~0 DAYS FROH ITS ISSUE DATE. IF <br />CONSTRUCTION FAILS TO MEET ALL REQUIREMENTS OF STATE LAWS AND MARION COUNTY BUILDING AND <br />ZONING ORDINANCES,~ THIS PERMIT 8HALL BECOME NULL AND VOID. <br /> <br /> REMARKS: HDSP OKAY TO CONTINUE HARDSHIP CONNECTION. ~r~!~ 2 Y~ ~/~/~ <br /> DONALD E. .____~., <br /> WOODLEY, MARION COUNTY BUILDING OFFICIAL / BY ...................... ~ ............... ~%_ <br /> <br />OFFICE COPY <br /> <br /> <br />