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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 S:O0 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> of ~ registered builder, <br /> The work wilt be performed by a registered builder. <br /> Other <br /> <br />(bwN'ER'. : TAX LOT; i'~A~~: <br /> CHECKAL,¢ JOHN <br /> <br /> BROOKSIDE <br /> NE ~ GONT~ACT GITY: :UGO: ~ OCCUPAHT LOAD~ <br /> OR 770~2 MARION COUNTY ~ NO <br /> AURORA <br /> <br /> GRIN ESTATES <br /> SAME " <br /> <br /> PHONE: 678-5414 VALUATION: <br /> <br /> ! <br /> 2 <br /> <br /> [ } 1.2 ] AC YES / NO <br /> TYPE: ON-SITE SEWAGE WATER SUPPLY: PW <br /> <br />PERMIT OR APPLICATIOH HO: <br /> <br />CONTRACTOR, NO. <br />CHECKAL, JOHN <br />SAME <br /> <br />PHONE: 678-5414 <br /> <br />TEST HOLES READY: NO <br />SITE EYAI,.OATION NOMBER: <br />EXISTING TANK SIZE: 1008 <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TAfl~ PUMPED: 11-16-,87 <br />PREVIOUS NO. BEDROOMS: <br /> <br />ITEM QUANTITY AMOONT <br />REPAIR - MINOR 1 $85.80 <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />TMIS'"RECEtPT <br /> <br />$85.00 <br /> $0.00 <br /> <br />BALANCE"DUE $0.00 <br /> <br />PAYEE: RECEIPT NO: <br />RECEIVED BY: TYPE: CHECK <br /> <br /> SEE ATTACHED DOCUMENT FOR REQUIREMENTS DF ON-SITE SEWAGE SYSTEN, <br /> <br />'*.THIS IS A VALID PERHIT /~ THIO PERMIT EXPIREO 36e DAYS FROi~ ITO ISOUE DATE. IF <br />CON,~TEUCTIOH FA~LS TO MEET ALL REQUIREMENTS OF STATE LAWo AND MARION COUNTY EUILDING AND <br />ZONING ORDINANCES~ TNIS PERMIT SMALL BECOHE MOLL AND VOID. <br /> <br />RENAF(KS: oEl' TI(, REPAIR <br /> <br />DONALD E. WOODL. EY, MARION COUNTY BUlL. DING 8FFl:CIAL / BY <br /> <br />OFFICE COPY <br /> <br /> <br />