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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 />Other <br /> <br />this document, <br /> <br /> I;O'bFREY. ~:'RNE'ST '75~-780 ( F(ESIDEN'I'ZAL <br /> · ' ....... <br /> . <br /> <br /> AUSMVILLE9884 SHAW SQU~RE RD <br /> <br /> ~ SITE NUMBER: 93-~1649 <br /> PHONE: i VALUATION: <br /> <br />L ~:,~:~ ~ 1877, 1~97468.~ SF ~ NO YES <br /> <br />TYPE: ON-SiTE SEWAGE <br /> <br />PERNIT OR APPLICATION <br /> <br />CONTRACTOR= NO,, <br />GOI)F'I:~E;Y. ERNEST <br />SANE <br /> <br />PHONE: <br /> <br />47010 <br /> <br />WATER SUPPLY <br />TEST I-IQLES READY: <br />SITE EVALUATION NUMBER: <br />EXiliSTING TANK S;[ZE: 1000 <br />EXIST.I:NG DRAIN FIELD LINES,". <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROOMS: 2 <br /> <br />500 <br /> <br /> :[TEN <br />AUTNORIZAT]:ON NOTICf-' - FLD~ VISIT <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />TI4iS RECEIPT <br /> <br />QUANTITY AMOUNT <br /> t $160,,08 <br /> <br />$160.00 <br /> <br /> $0.00 <br /> <br />BALANCE DUE $8.00 <br /> <br />PAYEE: RECE.I:P'f' NO: <br /> <br /> REIJ:.IYE~ BY: PB ................................................................. TYPE: CHECK <br /> <br /> SEE A'I'TACHE~ ~OCU~EIqT FOR R~Q]~E~E~T'S OF- ON-~IT~ SEWAGE 5YSTE~. <br /> <br /> * THIS ~8 A VALID PERMIT * THIS PEEMI~ EXPIRE~ ~6~ DAYS FROM IT~ ISSUE <br />CONSTRUCT'.ION FAILS TO NEET ALL R~EQUtREHE',NTS OF STATE LAWS AND MARION COUNTY <br />ZONING ORBINANC~S., TI4:I;S F'ERM~T SHALL BECOME' NULL Al,ID <br /> <br />t~Ei4 ARI<.S .' f~ Lt'l'l"l <br />DONAt...]O E,. WOODLI'-"Y~ NARION CCIUWTY BU,,SLD~'N[; OFFIC?AL / BY <br /> <br />FORM # MD 15.~ REV. ~ OFFICE COPY <br /> <br /> <br />