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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
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<br />I am performing work on a property I own or occupy.
<br />I am a registered gui{der OR ( ) the authorized representative
<br />of a registered gvilder,
<br />
<br /> :1.].704 P, I I-I k DJ-(
<br />Af,,~MrV i L I_E OF(
<br />
<br />28~;~5 SW ~_,,41'H
<br />H;~L~;SBQRO,, OR 9712; [ SITE
<br />
<br /> :' CONS~RO~ION ?¥PE:
<br />9 ? 3 .'.:.! :~ ! i OCCUP^NT LO^P:
<br />
<br />TYPE: ON-SiTE SEWAGE
<br />
<br />PERfllT OR APPLICATION NO:
<br />
<br />COt'!TP, ACTOR,~ NO,,
<br />[...O~E, DO[J[
<br />
<br />H,t,L,L,~,OEO~ Ok ~7~23
<br />PHONEi'.
<br />
<br />47212
<br />
<br /> WATER SUI:'PL Y
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<br />· TEST HOLES READY:
<br /> S.C.'rE E-VALUATION NUHBER,~
<br /> I:.X.I.,.IT 1HG 'I S l ZF."
<br /> I'.:.XIST~N(~ N i:'i'~LD L:I.I'IES.
<br /> S~'-'F'TIC TANK PU~PED~
<br /> PREVIOUS NO. BEDRO[]MS::
<br />
<br />EXISTIN(;- ,:*Yc~fl2f'!. EVAL. RF"T.
<br />
<br />'TOTAL ASSEooED FE,F,.,;~
<br />PREV:rOUS RECEIPTS
<br />THiS RECEIPT
<br />
<br />(i~UAN'f ITY AMOONT
<br /> 1 ~,:1. 6 0 ,, 0~
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<br />BAi..AHCE DUE' ¢0,. 00
<br />
<br />l:¥WEE: RECEIPT NO: (~
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<br /> RELE.[VL%,D BY= F'B ........................................................................................ I'YI-"E= CHECK ~ 0
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<br /> ob.E ATTACHED DC ;',UMSNT FOr( REgUIREHEN'f'S OF ON-SITE SE~AGt:: SYS
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<br /> THIS IS A VALID PERMIT ~ THiS P~IT EXPIRES ~88 DAYS FRO~ ITS ISSUE DATE. IF
<br />C,.)I~,.~Rt. ICF],~ N F'AZLS TO NEE'Y' ALI,. R~,QU],i, ~.MENT,.~ OF ~TATE LAWS AND MARION COUNTY ~kl.J]:',_.P'.[N(;
<br />ZON;:N[~ O~DINANCISS.~ THIS E,f~H.[T SHAI,.L ~.)ECO~E NULL. AND VOID.
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<br />RE~ARKS~: L:SIi!,' STAY'tON F,'ii;F:IORTS I,.i~:C;H Lt~LItD L,i'_-';VL~],,, IhI TANK.
<br />DO~'-IAL. D E. i,,]00:0Li'.-':Y~ EAI:IION COLihF[Y I~UZLD:[NG OFFICIAL /
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<br />OFF~OE COPY
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