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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> · <br /> <br /> PHONE: 588-51~7 8;00- 4:30 <br /> 24 HOUR CODE~A-PHONE: 588-7904 <br /> <br /> TAX LOT; .......... <br />JACK ; RESIDENTIAL <br /> <br /> 9741 JORDON ST SE :'~5~f~'i~f'ci'r',;i ..... ;of~ .... z <br />AUN,gVTI..LE OR 97~25 ~ NARION COUNTY~ NO ~ <br /> <br />SAM[': <br /> <br />PNDNE: <br /> <br />8ITE NUHBER: 93-83283 <br />VALUATI'ON; <br /> <br />TYPE: ON-5ITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />COHIRAC¢OR, NO. 8o815 <br /> A ~ B Seotic Service I¥~c <br />7~2[; W',imd~or Is Rd N <br />FHONE: 3~-1311 <br /> <br />5~148 <br /> <br />WATER SUPPLY <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN ;IELD LINES; <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEPROOMS: <br /> <br /> ITEM QUANTITY AMOUNT <br /> REPAI~ - MINOR 1 $85,00 <br /> <br /> TOTAL ASSESSED FEES $85,00 <br /> PREVIOUS RECEIPTS $0.00 <br /> THIS EECEIP~ <br /> <br /> PAYEE: A & B Septic Service :- RECEIPT NO: 525],8 <br /> RECEIVED BY: CL TYPE: CK CHECK 8: 0 <br /> <br /> SEE AllACHED DOCUMENT FOR REQWIREfiENTS QF,'ON SITE SEWAGE SYSTEM. <br /> <br />60NSTI:~UCT:[OIg FAILS TO MEET ALL REQUIREMENTS OF STATE LAWS AND MARION COUNTY BUILDING AMD <br />Z[/l,llN~ ORDINANCES~ TNIS PERMIT SHA~L BECOME,NULL AN9 <br /> <br />DONALD E,, <br /> <br />R F" R: M i N <br /> <br /> WOODI...Iii:Y~ MARION L, OLNYY BUILDING OF'FI.CIAL / BY <br /> <br /> OFFICE COPY <br />FORM # MC 15,~6 REV, 4/90 <br /> <br /> <br />