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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 - 4:80 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />of a registered builder, <br /> <br />Other <br /> <br />I have read and agree to the terms stated on the reverse side of <br />this document, <br /> <br />~ ~)ATE.' 10/'.."//~3 TZHE; ~.1:::L2.'.2.~, .............................................................. <br />~ OWNER . TAX I. GT: CATEGORY: : <br /> <br />" 13183 BROOKSIbE ~R ~ ' <br /> <br />  BYRON GRIMM ESTATE8 <br /> APPL. ICANT: JONN CHE~KAL <br /> 13213 BROOKSIDE DR NE 97~2 SITE HUMBER-' <br /> PHONE: &78-54t4 VALUATION: <br /> <br />TYPE: ON-SiTE SEWAGE WATER SUPPLY: PW <br /> TEST HOLES READY: <br />PERMIT OR APPLICATION NO: ~671 SITE EVALUATION NUMBER: <br /> EXISTING TANK SIZE: 1000 <br />CONTRACTOR, HO. EXISTING DRAIN FIELD LINES: <br />PAUL, STEVEN SEPTIC TANK PUMPED: <br />APPLICANT: JONN CHEOKAL .,~',,.~=-',"..':. '., t,PREVIOUS'NO. ,BEDROOMS: <br />1~21~ BROOKSIDE DR NE ~7082 <br />PHONE: 678-5414 <br /> <br />280 <br /> <br /> ITEM QUANTITY AMOUNT <br />REPAIR ~ MAJOR 1 $125.~0 <br /> TOTAL ASSESSED,FEES $125.00 <br /> PREVIOUS. RECEIPTS $1~.~.00 <br /> ":THIS' ..... ~E~EI, PT- <br /> $0.00 <br /> <br />PAYEE: RECEIPT NO: <br />RECEIVED BY: TYPE: CHECK <br /> <br /> PB 0 <br /> <br /> ~ THIS IS A VALID PERMIT' ~,'TH,IS PERMIT; E,XFIRES ~&~ DAYS ~FROM ITS ISSUE DATE. IF <br />CONSTRUCTION FAILS TO ME~T, AL~ REQUIREMENTS 'OF STATE LAWS A~ND MARIO~ COUNTY BI lLDING AN~ <br />ZONING ORDINANCES~ THIS FERMIT SHALE BECOME' NULL AND'VOID. ', ' ' <br /> <br />REMARKS,, SEPTIC REPAIR <br />DONALD E. WOODLEY, MARION COUNTY BUILDIN~ OFFICIAL / BY ~_~_.._ <br /> <br />FORM # MC 1 ~-58 REV, 4~0 0 F FIC E COPY <br /> <br /> <br />