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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: 5S8-7904 <br /> <br />[ am performing work on a property I own or occupy. <br />l am a registered builder OR ( ) the authorized representative <br />of a registered builder. <br />The work will be performed by a registered Puilder. <br />Other <br /> <br />I hove read and agree to the teems stated on the reverse side of <br />this document. <br /> DA'I"E: 08/09/9S TIME: 1.5:55:SS <br /> <br />S~GNATURE OF APPt. tCANT: <br /> DATE; <br /> <br /> 7940 STONEF:rELD CT SE ] <br /> <br />79~¢ STONEF~EL~ OT SE <br />~U~SVILLE 8~ ~7~2~ ............ ~'~H~~8 ~ <br />PHONE: 945~6222 V~LU~TZON: : <br /> <br />TYPE: ON-~ITE SEWAGE <br /> <br />PERHIT OR APPLICATION NO: <br /> <br />CONTRAC'TOR~ HO. <br />KAILEY, JOHN h. <br />7930 STONEFIELD CT SE <br />AUMSVILLE OR 97~25 <br />PHONE: 945-6222 <br /> <br />9~48973 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: YES <br />SITE EVALOATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK POMPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM <br />SITE EVALOATION, FIRST LOT <br /> <br />OUANTITY AMOUNT <br /> i $265.00 <br /> <br />TOTAL ASSESSED FEES $285.00 <br />PREVIOUS RECEIPTS $0.00 <br />THIS ~ECEIPT $265,00 <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE. KAILEY, JOHN M4n RECEIPT NO. <br /> ......... .... <br />SEE AT'fACHE~ DOCUMENT:[""OR RE'QUiRENENts OF'ON-SITE SEWAGE SYSTEM. <br /> <br />NOTE: THIS DOES ~IOT GRANT OR IMPLY FERMtS~ION TO BUILD ON TH~,S PARCEL. PLAMMING AND <br />ONSTRUCTION PERMITS ftUST BE OBTAINEB BEFORE BUILDING OR ~EPTIC INSTALLATION BEGINS. <br /> :' AN REVIEW, BY ~DATE ~ CITY JLRISDIC'fION, BY DATE <br /> REMARKS: SE/TH:READY 8/~/~ ' <br /> <br />~o~ ~ Mc ~s-s~ ~.,A,'S'O OFFICE COPY <br /> <br /> <br />