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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 />miLE <br /> <br />of a registered builder, <br /> <br />Other <br /> <br />SIGNATURE OF APP <br /> <br />bWNER; ~'A'TE"'"OS'/OS/r¢7~ .......... TI4'tIE-~.-J.5...4c..A8 .............l'y~,'~ LOt; .................................. <br /> <br /> W[LL[A~S~ FEANKL[N Du & DELORES RESZSENT[AL <br />. ~,~O~ ~'~ ................. ~~ ................................ ~f~O~ .... OCCUPANC~ ' " <br /> <br /> 89~9 SHAW SQUARE RD SE ~6'~c~-~fi~; .............. ~8'~7 <br /> AUHSVILLE O~ ~7~25 ~ARION COUNTY NO, ,: <br /> ........................................ ----_ ............................. . . <br /> <br />SAHE <br /> <br />PHONE: 585-221~ <br /> <br />.... WALI;,~L ~ILLSZEBUI~£~ .......... <br /> <br /> SITE HUMBER; 9S-~3~84 <br /> VALUATION: <br /> <br />TYPE~ OH-SITE SEWAGE <br /> <br />PERHIT DR APPLICATIOH HO= 9849741 <br /> <br />CONTRACTOR. NO. <br />WILLIAMS. FRANKLIN D. & DELORES <br />SAME <br /> <br />PHONE 585-2210 <br /> <br /> ITEM <br />EXISTING SYSTEM EVAL; <br /> <br /> PAYEE.~ WILLIAMS~ <br /> RECEIVED BY: MB~ , <br /> <br /> SEE ATTACHED DOCUMENT <br /> <br /> ~ THIS IS NOT A <br />FOLLOWING MUST BE <br />ALL NECESSARY INFORHATI,ON <br /> <br />WATER SUPPLY: P.W <br />TEST HOLES READY: <br />SITE EVALUATION NUMBE~: <br />EXISTING TANK SIZE: 1880 <br />EXISTING BRAIN FIELD LINES: <br />SEPTIC TANK BUMPED: 9/7/93 <br />PREVIOUS NO'~'BEDROOMS: ~ <br /> <br />450 <br /> <br /> F~ES <br />~TS. <br /> <br />QUANTITY AMOUNT <br /> i $16~.00 <br /> <br /> $160.80 <br /> $0.0~ <br /> '~,':;;.:.:2_ $160.00 <br />5' ?:....., $0.80 <br /> RECEIPT NO: 52105 <br /> TYPe: CE CHECK ~: 7813 <br /> <br />THAT <br /> <br /> OFFICE COPY <br />FORM # MC 15.56 R~V, <br /> <br /> <br />