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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG, NO, 225 <br /> · " 220 HIGH STREET NE ~ <br /> SALEM, OREGON97301 ~" I ' <br /> PHONE: 588-5147 8:00 - 4:80' L .._~ <br /> 24 HOUR CODE-A-PHONE: 588-7904 , ~ <br /> <br />O,h,r. % <br />I have read and agree to the terms stated on tl~o reverse side of DATE; ~-,~ <br /> <br />I ows~R; ~OAT'E.,. 08/10/92{ TIME~ :l, 4:2.Z'-5'7, ........ !'"f~k 66~i ...................... <br /> B.[,~o[:,LL,~ ANNETTE ~ 74442-~71 ~ NE~I~[:,NTIAL i <br />8~yus aoe~zss: = .................................. <br /> J OONSTR~CTION TYPE'. <br /> : ! <br /> <br /> AUMSVIL. LE OR ~7325 ~, MARION C~UNTY NO <br /> <br /> ~ SANTIAM SF'RZNGS <br /> 48~e -, 71ST AVE SE <br /> SALEM ~7~81 ~ITE HUmBEr: <br /> F'HONE: 7~62~6:L8 ~LUATIONJ <br /> <br />fW~DTH; IDEPTH; / IRREg. LOT; <br /> , AREA'. ! UNITS ' CORNER <br />I ! ¢ 2.2,!~ AD i YES qO <br /> <br />TYPE: (}N-SITE SEgA~,E <br />PERH'Ir T OR <br /> <br />CO~?~6C'TOR~ <br />BZSSELL,, 6NNETTE <br />489B - 710T AVE SE <br />SALEM <br />F'HONE: 362-3618 <br /> <br />9~48797 <br /> <br />WATER SUPPLY: PW <br />TEST FBLES READY: <br />SITE EVALUATION NUMBER: <br />EXIST~ TANK ~IZE: <br />EXISTING DRAIN FIELB LINES: <br />SEPTIC TANK PU~PED: <br />PREVIOUS ND. BEDROOMS: <br /> <br /> ITEM QUANTITY AMOUNT <br /> STANDArd) ON-SITE SYSTEM 1 $,~,,¢5,,"~'" 00 <br /> <br /> "s <br /> <br /> ,B~CE'"~UE $0, ~ <br /> PAYEE: KENNETN W~)~S ' ':?'.~,-',' '- ~ECEIPT NO: 5]~41 <br /> RECEIVE~ BY: DH2 ., I~ ~ TYPE': PI( PN~rk' a.' Y~=lX <br /> SEE ATTACHE9 DOCUMENT F'OR':REQUi'EE~ENT$ OF,~DN-S[T~':S'E~AGE SYSTEM. <br />~ THIS IS NOT A PERHIT. THZS. ~PLZ~T'~ON HUST GO ,THR~ a REVIEW PROCESS ~ERE T~ <br />[9[..LpWING H?'I' BE COMPLETED, II' IS. THE] 'RESPONSI~LITy OF T4E APF'LICANT 'fO ASSURE TMA'F <br />~4t.L MECESSARY ?FOR~ATI'ON NAS BEEN PROYI'QE~ .... ' ' <br /> <br /> F L~i,i <br /> RE'qJ;EW; <br /> <br />FORM # MC 1~-~$ REV. 4/90 OFFICE COPY <br /> <br /> <br />