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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OBEGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: E88-7904 <br /> <br />Other <br /> <br />this documerd. <br /> <br />OWNE.: DATE: <br /> <br />T ,,M~. .... 8;42:5& <br /> <br />TAX LOT <br /> <br /> 15180 PARK AVE NE <br />USE O~ <br /> OR <br /> ~7,00~ <br /> <br />CONTRACT CITY; UGE <br /> <br /> ~ARION COUNTY · YES <br /> <br />AGLN l',, MAR~ IN CI,,,ARK 678-1 <br />PO BOX 1~8 AIJRORA 77a~2 SITE <br />PHONE: 578-2764 VALUATION: <br /> <br />MAP: <br /> <br />, V~iOTB: DE'TH: ~RE~3 '" U N iT~Cf S c~. LOT ..........C(~l~j ~R,. '3 <br />............................ ?%- ........ A£ .... YES ......... b:O <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR~ NO,, ~6748 <br /> Joht~ L J!~rsey & Son Inc <br />70:L5 NE 42nd <br />P, or tland. 97218-88~ <br />FHONE~ 287-4185 <br /> <br />49733 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES ~EADY: <br />SiTE EVALUATION NUNBEF(: 489~7 <br />EXISTING TANK SIZE: <br />EXISTING I~RA~N PIELD LINES: <br />SEPTIC TANK PUMPED: <br />PRE¥IOUS NO. BEDROOMS: <br /> <br /> ITEM QUANTITY AMOUMT <br /> STANDARI) ON-SITE SYSTEM 1 $,_u,¢.00°='; ~ ' <br /> <br /> TOTAL A$SESoED FEE~ <br /> PREVIOUS RECEIPTS $255~ <br /> THIS F(ECE IPT $~,, <br /> <br /> BALANCE DUE $~. <br /> <br /> F AYEE. RECEIPT NO: <br /> RECEIVE~ BY: PB ................... ~; ................................. TYPE: CHECK ~: <br /> SEE ATTAO-IED DBCUMENT FSR REQUIREMENTS OF ON--SITE SEWAGE SYSTEM. <br /> <br /> * THIS IS A VALID PER~IT * THIS PERMIT EXPIRES ~8 DAYS FROM ITS ISSUE DATE. IF <br />CONS'Y'I%ICTION FAILS TO MEET ALI. REQUIREMENTS OF STATE LAWS AND MARION COUNTY [UIL. D,[hG~ ' " Al,ID <br />ZONING OI~DINANC, ES, THIS F'ERHZT SHALL BEGONE NULL AN~ <br /> <br />REMARKS: oS~ RI;,S <br />DO~,IAI,,D E,, WOODLEY,, MARION COUNTY BUILDING OFFICIAL / BY ................ ./~_.. ................................................................ <br /> <br />FORM N MO 15-56 REV, 4/90 <br /> <br /> <br />