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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONlE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> The work will De performed by a registered builder. <br /> Other <br /> <br />:DATE; ~1IJ, 7/95 T~HE: <br />~ ........................ <br />MOFd;AN~ ROM . 76~.5],0~0 ~ ESIDEN:TIAL <br /> <br /> 8144 AJM,N.[LLE HWY <br /> OCCO~AN~ <br /> <br /> , ~b6~; .............................................. ~'~5;vi~iS~T ............. <br /> Sn~E <br /> PHOWE= 743-88:*5 _[ VALUATION: <br /> <br />TYPE: ON-GITIE SEWAGE WATER SUPPLY: F'W <br /> TEST HOLES READY: <br />PERM]IT OR APPLICATlCON 140: ~B717 SITE EVALUATION NOMBER: <br /> EXISTING TAWK SIZE: <br />{;ON'~F~ACI(1R~ NO. ,3~9:t.G EX~STING DRAIN FIELD LINES: <br />STAYTON S~PT:~C SEPTIC TANK PUMPED: <br />1.I.,~,~ STAYTOM ~(3IO DF( SE <br />S'fAYTON~ <br />PHOME~ 769--2C~2 <br /> <br /> ~TEH <br />AL l' ~-~RA T I ON <br /> <br /> PAYEE ~ <br /> RECEIV[::D BY," cl !:' ~:'!:: <br /> <br /> SEE ATTACHED DOCUMENT <br /> $ TH:[[; IS A VALID pERil'iT ~: <br />CONSTRUi3T]:LtM FAILS TO M~-."F.]::1* <br />ZON],'N(; OF:D]],~ANC~S, I'NZ$: PER:M] <br /> <br />: : QUANTITY AHOUNI <br /> 'i' ,~": ':: :~ :,::;i = 1 $280.98 <br /> <br /> g" $28~,, ~b <br /> <br /> RECEIPT NO: <br /> .,, ........ ~ TYI E. CN[_CIs ~, 8 <br /> <br /> ',~AND VOZD; <br /> ,: <br /> <br />:(,'i:MAr:'KS: SSt1,41..'[' <br /> <br />DOI,!AI,.D E,. W[ ODL, EY,, <br /> <br />COUNTY BLI:[L.D~NG OFFICIAL/ BY , ...................................................... <br /> <br />OFFICE COPY <br /> <br /> <br />