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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 />lamareglsteredbuilderOR( )theauthorizedrepresentatlve <br />of a reg{stered builder, <br /> <br /> CATEGORY'. <br /> UXLLIAMS., JACKIE J RESIDLENTI~L <br /> §lTY~ A~F.~: ' CONSTRUCTIONTYPE'. <br /> <br /> ALIMSVILLE OR 97325 ~ MARION COUNTYI NO ~ ; <br /> <br /> SITE NU~BER: 93-~2655 <br />~ PNQNI~a 749-~9~:L VALUATION: ! <br /> <br />,LOT: <br /> <br />TYPE: OH-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CON'TRACTOR~ NO. ~4916 <br /> STAYTON SEPTTC <br />4I]..~o STAYTON SCIO DR SE <br />STAYTON~ 97S8~ <br />PHONE: 769-2502 <br /> <br />488~6 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: W/CALL <br />SITE EVALUATION NUMBER: <br />EXISTIN~ TANK SIZE: 250 <br />EXISTING DRAIN FIELD LINES: <br />9EPTIC TANK PUMPED: 4-,9~ <br />PRE¥IOQS NO~ BEDROOMS: <br /> <br />ITEM QUANTITY AMOUNT <br />REPAIR - MAJOR I $125,,00 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS,RECEiPTS <br />THIS RECEIPT <br /> <br />$125.00 <br />$125.08 <br /> $0.00 <br /> <br /> BALANCE. DUE $0.00 <br /> <br /> PAYEE: RECE~P?' NO: <br /> RECEIVED BY: PB .................................................. TYPE: CHECK $: 0 <br /> <br /> SEE ATTACHED DOCUMENT ~OR REQUIREMENTS OF,ON=SITE SEWAGE. SYSTEM. <br /> <br /> * T~IS IS A VALI~ PE~HIT * TH~$ PERMIT EXPIRES3&~ DAYS FROM ITS ISSUE DATE. ~F <br />CONSTRUCTION FAILS TO MEET ALL REQUIREMENTS OF STATE LAWS AND MARION COUNI'Y BUIL~ING AND <br />ZONING ORDINANCES, TNIS PERMIT SHALL BECOHE NULL AND VOID. <br /> <br />REMARKS: RI R,,MA,,~,, <br /> <br />D[3NAI.,D F,, WOODLEY~ <br /> <br />FORM # MC 15.58 REV, <br /> <br />PRESSURIZED DIS'TRIBUTION~ SOMEWHAT SUB,S'TANDAF(D~ REF'Ai~ <br /> HARIOI,I COUNTY BUILDING OFFIC:[AL / BY ~ ~.~ <br /> <br /> OFFICE COPY <br /> <br /> <br />