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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 FILE <br />Other_ <br /> <br /> i TAX LOT: iCATBGORY; <br />SITUS ADORESS: ................................... CONSTRUCTION TYPE: ; OCCUPANCY <br /> <br /> DETROIT OR ~7542 ] gETRO]:T , I~0 65 <br /> PO ~OX ~S7 ........................................................................ <br /> <br />TYPE: ON-SITE SEWAGE <br />PER~I[~ OR APPLICATION NB.- 50110 <br />c oi,m:m c'?,,,o?, lqo,, <br />~ANN DARM. ENI.-] <br />F'O ;lOX 367 ': <br />?ANHA, !IRE£;ON 97S50 <br />FHONE: 854-~7~5 <br /> <br />WATER SUPPLY: CW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXIST];NG TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUHF'I~D: <br />F'F,'E¥ i['!)lJ S <br /> <br /> ITEM <br />ADDI'fIONAL SUBSURF'ACE FEES <br />A:~)DZ'fIOMAL SUR(:',HARI;;E - SUBSURFACE <br /> <br /> TOTAL. ASSES,~ED ;FEES <br /> :: :PREVIOUS:: REOCI:PTs <br /> :,TH~.p I-,ESE .[P,T <br /> <br />PAYEE: MANN DARRLENE <br />RECIEIVED Bt,, CR <br /> <br />QUANT I TY AftOUNT <br /> :1, ,b .?J..10 <br /> <br />$8S., <br /> $0.00 <br />185, 00 <br /> <br />' IN¥OICE NO: <br />: TYF'IE: IN CHECK <br /> <br />**THI~ IS A VALID PERMIT:*:: THIS'P~IT EXPIRE~ ~8 ~AYS FROM ITS ISSUE DATE. IF <br />CONSTRUCTION FA:I? TO MEET ALL ~EQUt~EMENTS OF SLATE LAWS: AND MARION COUfl'Y BJtll)'~ <br />',~o,,~:,:~,~ o~:~,,~.~o~'.s, Tm'.s ?~m~:r s~:~A~_ ~cO~~ ,:~UL~ A~,~ Vo~.: ....., <br /> <br />FORM # MS 15-58 REV. 4/90 OFFICE COPY <br /> <br /> <br />