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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 />Other <br /> <br />SrGNATURE OF APPLICANT; <br /> DATE; <br /> <br />OWNER: :OATE:i 0':?/2qt9S TIME: <br /> <br />TAX LOT: <br /> <br />CATEGORY; <br /> <br />o ~.~ ~':~N T I AL <br /> <br /> $7;~4 SHAW [;OtJARF_ RD Si.-7, <br />Alt ~ <br /> OR <br /> 97325 <br /> <br />MARION COUNTy NO <br /> <br />P H 0 ii E :, ;3 64 - :t 6 5 5 <br /> <br />SITE NUMBER: 93-02771 <br />YALUATION: <br /> RANGE: : ZONE; <br /> <br />MAP: <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO; <br /> <br />C.[.NTkACIOk,, NO. .36949 <br /> AAA SFF'TIC SERVICE <br />F'S BSX 20Sll <br />,~ ~ I. ,F.i~ ,~ 97307 <br />F'HONE: ~78-'7454 <br /> <br />9850267 <br /> <br />WATER SUPPLY: PW <br />TEST HOt. ES READY: YES <br />SITE EYAI. UATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK F'HMPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br />ITEM QUANTITY A ~'t(]UI,iT <br />RFF'AIR - MAJOR 1 $125.0~ <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECE,t,F 1S <br /> <br />I]25.00 <br /> $0.00 <br /> <br /> O~ 'S~°fl°~ THIS ReceIPT ~0,,00 <br /> , ~. BALANCE DUE $125,,00 <br /> <br /> REOe]:W~ aY~ CL ~]S ~A~%~ ~a~L TYF'E: .CHECK ~: 1587 <br /> SEE AI"rACHKD DOCUMENT FOR REQOIREHENTS OF ON-SITE SEWAGE SYSTEM. <br /> * THIS IS NOT A P~RMIT. THIS A~PLICATiOHWUST GO THROUGH A REVIEW PROCESS WHER~ THE <br />FOL[..OWB~G MUST B~ COMPLETED. ~T ~S THE RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INF'ORMAT~ON HAS BEEN,PROVIdeD. <br /> <br />REMARKS: RPR:HJR TH:9-29-93 <br /> <br />CITY JURISI)ICTION: <br /> <br />BY ................I)A'¥'E ................. <br /> <br />OFFICE COPY <br /> <br /> <br />