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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 />The work will be pedormed by a registered builder. <br />Other. <br /> <br />SIGNATURE OF APPLIC '.~'.~ <br /> <br /> F ~O-~¥~' ~ ~'~- - - g~B'. OCCUPANT LOAD: <br /> ].3924 EMLEN RD hie J <br /> ................................. NO <br /> <br />LARRY KRIBS <br /> SITE NUN~ER: <br />PHONE: ~78-2141 VALUATION: <br /> <br />TYPE: OH-SITE SEWAGE <br /> <br />PERHIT OR APPLICATIOH <br /> <br />CONTRACTOR. NO. <br />PACIFIC TELECOM IgCu <br />LARRY KRIBS 678-214] <br /> <br />PHONE: 678-2141 <br /> <br />9949g~5 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: NO <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING BRAIN FIELD LINES: <br />SEPTIC TANK PUMPEB: <br />PREVIOUS MO. BEDROOMS: <br /> <br /> ITEM QUANTITY AMOUNT <br /> REPAIR - MAJOR I $125.08 <br /> TOTAL. ASSESSEB FEES $125.88 <br /> :'REVIO JS ,RECEIPTS '~18.88 <br /> THIS 'RECEIPT $125.88 <br /> <br /> ~ 'BALANCE' DUE $8.88 <br /> PAYEE: PAC;fF'[C TELECOM INC. ~ ~,: - , ": RECEIPT NO: , 51368 <br /> RECEIVEB B~:'~H2- ' _~~"' , 'TYPE: OK CHECK ~: 38e&28 <br /> <br /> SEE ATTACNE~ BOCUHENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYgTEM. <br /> <br /> ~ THIS IS HOT A PERHIT. THIS APPLICATIOH HUST ~ THROUGH A REVIEW PROCESS WHERE THE <br />FOL[.OB~NG.HJST ~E COHPLETED. IT IS THE, RESPONo[~IL[TY OF THE AI-FLIC~NT TO ~,~.~UEE THAT <br />ALL MECESSARY INFORMATION NAS BEEN F~ROVIDED. <br /> <br />REMAI,,kS,, MAJ REPAIR TN:READY bio <br /> <br />CITY JURISDICTION: BY ............................ I)ATE ........................... <br /> <br />OFFICE COPY <br /> <br /> <br />