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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STREET NE <br /> SALEM1 OREGON 97301 <br /> <br />I am a registered builder OR ( ) the authorized representative <br />TMe work w~ll be performed by a registered builder. <br /> <br />this document. <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 888-7904 <br /> <br />D~TE;; 06/17t9','~ <br /> <br />TOWEF,'Y, W.I. LL,,[A ~ <br /> <br />j LGT: <br /> <br /> RESIDENTIAL <br /> <br /> SE "Sb ~'fi~f- 8i:R~ odcUP×NT dO~o; <br />}7S92 MARION C ]UNTY~ NO <br /> <br />TYPE; ON-SITE SEWAGE <br /> <br />PERMIT ~3R APPLICATION <br /> <br />CONTkAC1OR~ <br /> CLWEkY, WILLIAM <br />SAME <br /> <br />PHONE: 769-7724 <br /> <br />9~47726 <br /> <br />WATER SUPPLY: F'W <br />TEST HOLES F,~EADY: <br />SITE i:[VALUATION NUMI'q::R: <br />EXISTING TANK StZE,~ 1000 <br />EXI, STING DRAIN FIELD LINES~ <br />SEi;"i"ZC TANK F'U~PEI): <br />PREVIOUS NO. BEDI~OOHS: <br /> <br /> ITEM QUANTITY AMOUN <br /> REPAIE - MAJOR 1 $125. <br /> <br /> TOTAL ASSESSED FEES <br /> PREVIOUS I~ECEIP'rB <br /> TEI;[S RECEIPT <br /> <br /> ~ALANLE DUE <br /> <br /> ~AYEE: TOWERY, WI[LZAM RECE'IPT NO: 58112 <br /> <br /> SEE ATTACHED DO6OMENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYSTEM, <br /> <br /> * THIS IS'~OT A PERMIT. THIS APPLICATION MUST GO THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST ~{E ~OMPLETE~, ~T ~'S THE RESPONSIBILITY OF THE APPLICANT TO ASSURE TRAT <br />Al J.. NECESSARY INFORMATION HAS BEEN F'ROV~ED, ' ' <br /> <br />FORM # MO 15-56/REV, 4/~0 <br /> <br />OFFICE COPY <br /> <br /> <br />