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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 />of a registered builder, <br />The work will be performed by · registered buiJder, <br />Other. <br /> <br />this document, <br /> <br />/ HOSEI% RONAI.,,D ,. 7455'S82i <br /> AUHSVIL[,.E OR 97;25 ~ HAil:ON COUNTY~ NO <br /> <br /> SINOR .... ~' '-e <br /> , <br /> ,, ,I=u AUI~UF(I~I R~ NE <br /> , Al. Ed ~ SITE HUMBER: <br /> PHOI'~E: ;~63-97-75 VALUATION: <br /> <br />TYPE: QN-8ITE SEWAGE <br /> <br />WATI~R SUPPLY: PW <br /> <br />PERMIT OR APPLICATtOH NO= 9847789 <br /> <br />TEST HOLES READY: <br />SITE EVALUATION NUM~ER: 81--~54 <br />EX%STING TANK SIZE~ <br />EXISTING DRAIN F~iE[_D LINES: <br />~EPTtC TANK PUMPED~ <br />PRE¥IOUS NO, BEDRO0~SI~ <br /> <br /> %]UANT;[TY <br /> A~OUNT <br /> STANDA~;:D _N--S,~TE SYSTEM' 1 <br /> <br /> TOTAL AS,~ooE~) FEES <br /> PREVIOUS RECEIPTS <br /> THIS RECEIPT <br /> N ~ F -' <br /> <br /> ~E. CE.[V~:,)) BY;; CI__ ............................................................. TYPE: CK CHECK ~ <br /> SEE ATTACHE~ ~OCU~IENT FOR RE(~UZREHEN'fS OF ON--S~:T'E SEWAGE <br /> · THIS IS ~OT A PER~IT. TH~ APPLiCATiON MUST CO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWIN~ HUST [q~ C(~HPLETE~, IT IS THE RESPONS',I',~ILITY OF THE AF'PL~CANT TO ASSURE THAT <br />ALL Nr.:,CE~,~AE( INFORMAT:[ON HA~ BEENPRC" I'~I~E~'. <br /> <br />FOR~ # MC 15-5~ R~V, ~ OF FICE COPY <br /> <br /> <br />