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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br />The work will be performed by a registered builder, <br />Other ,, <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> SIGNATURE OF p <br /> <br />WII..L,~A~S~ JACKIE :~ <br />AUHSVIL,LE .... OR 97325 ~ MARION COUNTY~ NO <br /> <br />SITE NUHBER: <br />VALUATION: <br /> <br />PHONE: 749-~;901 ~ <br /> IDEPTH'. , <br /> <br />RANGE: i ZONe; <br /> LO'r; <br /> NO NO <br /> <br />TYPE: ON=SITE SEWAGE <br /> <br />PERMIT OR APPLTCATiON <br /> <br />CONTRACTOR~ NO. ~4916 <br /> STAYTON SEPTIC <br />41155 STAYTON SCIO DR SE <br />STAYTON, 97~8~ <br />PHONE: 789-2302 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: W/CALL <br />SITE EVALUATION NOMBER: <br />EXISTING TANK SIZE: 250 <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: 4-93 <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM <br /> QUANTITY AMOUNT <br /> REPAIR - MAJOR 1 $125,00 <br /> TOTAL ASSESSE~ FEES $125.0~ <br /> RREV~OUSRECEIpTS' <br /> TH~S~.REC~ipT, $0.00 <br /> ......... <br /> <br /> PAYEE: STAY'TON SEPTIC RECEIPT NO: , ~lI~e. ~ <br /> RECEIVED BY: PM2 ................................. TYPE: CA CHECK . <br /> SEE ATTACHES DOCUMENI FOR,REQUIREMENTS O~ ON-SITE ~EWAGE~SYSI'EM. <br /> <br /> ~ THI~ I~ HOT A ~E~MIT. THIS' APPLICAT,IOH MUS~',r~) THROUGH A REVIEW PROCESS ~NERE THE <br />POLLOWING MUST ~E COMPL£TED. IT ISi THE :'RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORMATION HAS BE~N PRQVIBEB. <br /> <br />FORM # MC 15-56 REV. 4/90 OF FICE COPY <br /> <br /> <br />