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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 - 4:80 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />~ am a registered builder OR t the authorized represen at ve <br /> <br />'dWN[~: )')4TIT ii ¢5 7 '.i: 7'/9..-/ <br /> <br /> 3.,JNSOI~ ~,.RL <br />, S TUS AOORESS: '~ <br /> <br />8754 N]:I...L C&-:.K RT} SE <br />.,.. ~ i,...L !_. 0~ '.:':f;()N ........... 0.~ .... ~_7.5~5 ...... <br /> <br /> ' E~LOCK. <br />LOT' <br /> <br /> SITE NUM~El~ = 9;~-e2083 <br /> YALUAI'I ON: <br />SECTION ....... TO'W~S~¢~:- ...........~i~: ' ................ ~"~b~ ' [ ~A~" .... <br />&~E~ UNIT~ IR~ LOT ~OREF~J .... ~' 5'1' <br /> ~c .............. ~ ........... l._._.{~ ......................... <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERflZT OR APPLICATION NO'- <br /> <br />CON'[k~[., fOk, ,N.]. <br />J Ol,,iFi,S 0 N ~ <br /> <br />F'HONE~ 747,"2601. <br /> <br />9047798 <br /> <br />WATER SUPPLY <br />TEST HOLES REhDY; <br />S?FE EVALUATION NUMBER: <br />EXISTING TANK SIZE;: <br />EXfS'I/'~:N¢ DRAIN FIELD f..:]:NES,". <br />SE'.PTIC TANK I;','UNPED~" <br />PF~EVIOUS NO,, BEDROOMS: <br /> <br /> I'TEH QUANT]:T¥ AMOUNT <br />AN!',IUAL EVAi ..... <br /> <br /> 'I'OTAL ASSESSE~ FEES $9¢~,,~ <br /> PR~; v~ Ol.S RECEIPTS <br /> <br /> BALANCE, DUE <br /> <br /> r;' :,, ~ RANSr ERE RECEIPT NO: <br />t,ECI:.~VI::.D BY:~ CL. ......................................................................... TYPE: CK CHI;CE 4~: <br /> <br />5';~t~;] ATTA(][,,[ED D~CUMENT FOR RE(~UIRCMENTS OF ON.,-SZTE SEWAGE SYSTEM. <br /> <br /> THIS IS NOT A PERMIT. T~ZS APPLICATION MUST ~ THRQU6H A REVIEW PROCESS WHERE <br /> KU,.~ }~: CUM~LE.~k~,. tS ,-1E REE;F'ONS]:glLITY OF "f'NE A'F'PLICANT TO ASSURE THAT <br /> HE, LE,.,,~AkY I%FSR;iAT)iON HAS 3EEN ~-,~v~)ED,. <br /> <br />FOR~, MC ~s-~ REV. ¢o OFFICE COPY <br /> <br /> <br />