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MARION COUNTY BUILDING INSPECTION <br />SENATOR 8LDG, NO, 22,5 <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 performed by a registered builder, <br /> <br />I have read and agree to the terms stated on the reverse sidQ of <br />this document, <br /> <br />I WASMAI,IN~ ER!K I RI;,~ I:DEN f .[AL <br />!';SIYUS ADO~E¢S; OCCUPAhCY: <br /> <br /> AUMSV]:LI_E Oi:~ ~7325 ~ MARION COUNTY,' NO <br /> <br /> SAHE <br /> PHO~IE: 581-1;~87 VALUATION: <br /> <br />WIDTH'. DEPTH'. i AREA'. ~1~1~; ' IRREG. LOT: ~ CORNER; <br /> ~ ~ .1.. 1 ,: AC, I NO " YES <br /> <br />TYPE: ON-SiTE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOE~ NO,, $4B!6 <br /> S'fAYTON SEPTIC <br />4.1,155 STAYTON $CIO DR SE <br />?AYTON, ~7383 <br />FHONE: 769-2902 <br /> <br />9858218 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING ~RAIN FIELD LINES: <br />SEPTIC TANK PUMPEB: <br />PREVIOUS. NO. BEDROOMS: <br /> <br />ITFH QUANTITY AMOUNT <br />REPAIR -- MA,JOE 1 ~1251, <br /> <br />PAYEE: ERIK WASMANN <br />RECEIVED BY: gM <br /> <br />SEE ATTACHED DOCUMENT F <br /> <br /> * THIS I9 MOT A PEEMI, T. <br />POLl_OWING MUST BE CO~PIJETE~ <br />ALL NECESSARY INFORmATION,HAS'BEEN PROVI'BE~. <br /> <br />TOTAL ASSESSEB FEES <br />~RE¥tOUS RECEIPT8 <br /> 3RECEIPT <br /> <br /> $125.~0 <br /> $8.88 <br /> $125.00 <br /> <br /> $0.00 <br /> <br /> RECEIPT NO: 52599 <br /> TYPE: CK BFIECK ~: 1126 <br /> <br />SEWAGE ,SYSTEM. <br /> <br />THROUGH A EEVIEW PROCESS WHERE THE <br />'Y OF THE APPI_ISAN'r TO ASSURE <br /> <br /> OFFICE COPY <br />FORM # MC 15.66 R~V, 4/90 <br /> <br /> <br />