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MARION COUNTY BUILDING iNSPECTION <br />SENATOR SLOG, NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />[ urn performing work on a property I own or occupy. <br />I am a registered builder OR the authorized representative SIGNATURE OF APP <br />of a registered builder, <br />The work will be perCormed by a registered builder. <br />Other <br />I have read and agree to the terms stated on the reverse side of DATE; <br />this document, <br /> <br />BOOZE~ KEI,INETH & JUDITH 40287-000 ~ <br /> RESIDENTIAL <br /> <br /> 18207 MATTMIEU LANE NE CbNTRAC~C~ b~', ~dOd>XW~'COXb~ <br /> AURORA OR 978~2 ~ MARION COUNTY[ NO <br /> <br />PHONE: <br /> <br />SITE NUMBER: 73-~2572 <br />VALUATION: <br /> <br />TYPE= OH-SITE SEMA&E <br /> <br />PERMIT OR APPLICATION NOs <br /> <br />CONTRACTOR~ NO. <br />BOOZE~ KENNETH & JUDITH <br /> <br />PHONE: <br /> <br />9~48696 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: FOR~ <br />PREVIOUS NO. BEDROOMS: <br /> <br />PAYEE: WAND-NELSOH <br />RECEIVED BY: cl <br /> <br /> ITEM QUANTITY AMOUNT <br />AUTHORIZATION NOTICE - FLD. VISIT 1 $160.00 <br /> 'TOTAL ASSESSED FEES <br /> PREVIOUS R~OE,I.PTS $16~,.00 <br /> - $0,,00 <br /> THISRECEIF,T $168.88 <br /> BALANCE ~UE <br /> 51016 <br /> <br />RECEIPT NO: <br /> <br /> .... - :=. =_= ~ TYPE: CK CHECK ~: 4442 <br />SEE ATTACHED DOCUMENT FOR REQU'IREMENTS .OF ON-SITE'SEWAGE SYSTEM. <br />* THIS IS HOT TFII A L TI 0 FI R C $ <br /> <br />PLaN REVIEW= ~Y ...... 'DATE_ Y JU~SP[eT[ON= ~Y ......... D~TE ........... <br />REMARKS: <br /> <br />FORM # MC 15-58 RE'V, 4/~O OFFICE COPY <br /> <br /> <br />