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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 />I ~m ~ registered builder OR ( ) the authorized regresentatlve <br />Other ,, <br /> <br /> 8952 SANTIAM LOOP RB <br /> <br />MAILING ADDR~ I SUBDIVISION: <br /> <br /> : SITE NUHBER: 93-~2674 <br />................. 1: HO~tE ~ . ....................................................... ' 3fALU~TIOE " .................................... <br />LOT'. BLOCK: BECTION; I TOWNSHtP; ~ RANGE: ~ ZONE'. ~ MAP'. <br /> <br /> L J ' 'N'~ <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR. NO. <br />TOWERY~WILLIAM <br /> <br />PHONE: <br /> <br />9848886 <br /> <br />WATER SUPF'LY <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXeS'TING TANK SIZE: <br />EXISTING D~AIN FIELD LINES: <br />SEPTIC TANh PUMPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br />ITEM QUANTITY AMOUNT <br /> <br />$0.00 <br /> <br />$0.08 <br />$8.00 <br /> <br /> TOTAL ASSESSED FLEES <br /> PREVIOU~'.RECEIPT~ <br /> THIS RECEIPT, <br /> <br /> BA'LANOE ~UE <br /> PAYEE: TOWERY.WILLIAN RECEIPT NO: 51208 <br /> RECEIVED BY: gL <br /> <br /> SEE ATTACNE9 DOCUMENT F~R,'REQUIREMENTS OF ON-SITE SEWAGE SYSTEM. <br /> <br /> * THIS IS NOT A P£RHIT. THIS'APPLICATIS~ HUST ~0 THROUGH A REVIEW PR8~£SS WHERE THE <br />POLLOWING MUST BE COMPLETED.., IT ~S THE RESPONS,IBILITY OF THE APPLICANT TO ASSORE THAT <br />ALL NECESSARY INFORMATION NAS BEE~ PROVIDED. <br /> <br />PLAN REVIEW:I BY ................ ~)ATE ................ <br /> <br />REMARKS: TRANSFER 1:-":~47726 TO THIS <br /> <br />CITY JURISDICTION: BY ................. DATE ............................... <br /> <br />OFFICE COPY <br /> <br /> <br />