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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 - 4:80 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />DATE: .......... <br /> <br /> o a re9 s ered bu Ider, <br /> ) The work will be pedormed by a registered builder, <br /> <br /> DATE: 08/07/?~ TIME;'. <br /> <br />OWNER; THOMPSOI% HARI[_YN & :,%~',;;~,L;3 <br /> <br />, ~ifO~ ADDRESS: <br />: 9024 KE'.ENE L.N SE "~~I~TY 'b~'e <br /> AUMOVI[..LE OR ?7325 i i 6680~YLbAD: ~i' <br /> <br /> ......................... <br />~d~ OF 8uiE6i~;:~ ......................................... ' <br /> <br /> .................................................... <br /> SAME <br /> PNONE:; ~4-].~.2~ ~ VALUATION: <br /> <br />~EbT: ~Lbcg ~A~f~ .............. f~'~ ~ ~-A~'~ .................. ~b'~ ...............~A~; <br />~ ~z, ............ ~-E~t 1'85~'i ....... <br /> <br />9~48958 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: 1000 <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: 7/14/?~ <br />PREVIOUS NO. BEDROOMS: 2 <br /> <br />300 <br /> <br />T'¥PE: UM-5ITE SEWAGE <br />PERMIT OR APPLICATION NO: <br /> <br />CONTI4ACTOR~ NO,. <br />THONPSON~ NARILYN & DONAL. D <br />SAME <br /> <br />PHONE: 364-1120 <br /> <br /> ITEM QUANTITY AMOUNT <br /> AUTHORIZATIOI,I NOT]:CE - FLD. VISIT 1 $160.,00 <br /> <br /> TOTAL ASSESSED FEES $160.00 <br /> PREVIOUS RECEIPTS $0.00 <br /> THIS RECEIPT $160.00 <br /> <br /> BALANCE DUE $0,00 <br /> <br /> PAYEE: MARILYN TWO~4~;S~ RECEIPT NO:: , .512~ <br /> RECEIVED BY: MB'1/~/~~ . TYPE: CE CHECK ,~. <br />_:_..:_..; ......... =========================== ........................................... <br /> SEE ATTACHED DOCUMEN'I ~OR REQUIREMENTS OF oN-SITE SEWAGE SYSTEM. <br /> ~ THiS Ig HOT A PERMIT. TH~$ ~PPL[CATIDN HUSTGO THROUGH A REVIEW PROCESS W~ERE THE <br />FOL. LOW~NG MUST BE COMPLETED. IT IS TNE RESPONSIBILITY OF 'THE APPLICANT TO A~SJ~E TNAT <br />ALL NECESSARY ~NF'ORMATION HAS BEEN PROVIDED. <br /> <br />PLAN REVIEW: I4Y ............ BATE ...... ~__ C;I;TY JIJRISDIC'IfION: BY ............................ )DATE ............................ <br /> <br />FORM # MC 15.58 REV. 4/~0 OF FICE COPY <br /> <br /> <br />