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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 />I ~¢~ pe¢lofming work on a properS/I own or occupy. <br />I am ~ regisLeted bultder OR ( the au horized representative <br /> <br />SIGINA'i~JRE OF APPLICAN¥: ........................ <br /> <br />, OWN~ rE, O~//'o3/g 1 <br /> MEAg~,JR~, HAROLO & ELAINE <br /> <br />AU~ OR 9?002 ' <br /> ~ NO. OF BEDROOMS. <br /> <br /> VALUAT [ ~: <br /> <br /> -~'~'~ .......... ; UNITS: RREG. LOT; ;, CORNER: <br /> 8,3 AC <br /> <br />WATER ~AJPPLY: PN <br />TEST HOLES READY: <br />SITE EVALUATION NUtflBER; <br />EXISTING TANK SIZE~ <br />~ISTiN6 D~ZN FIELD LINES: <br />SEPTIC T~K ~MPED: <br /> <br />ANNUAL EYAL. - 'rEl~lp OR HD.E~p ~ .,(~ ... <br /> <br /> · TOTAk..'AE,~ED 'FEES <br /> :' ': :PREVIOUS'RECEiPTS <br /> %~.. THiS RECEIPT' <br /> <br />C~JAN'f'Z'rY AC4OUN'T' <br /> <br /> $60.00 <br /> $o.oo <br /> $~o.oo <br /> <br /> $0_00 <br /> <br /> 35261 <br /> 4~70 <br /> <br /> PAYEE: MBADO&~, HAROLD & EL~J. NE RECEIPT NOt <br /> RECEIVED <br /> <br /> SEE AT'FA~ED ~'1' ~OR RE~t.R~'F8 <br /> <br />ALL NE~y IN~TI~', H~'-BE~ P~i~O. <br /> <br />CZ'fY· JURISDiC'FION: 8Y <br /> <br />DATE <br /> <br />FORM ~ MO 1~.5¢~ REV'. 4/'90 OF FlOE COPY <br /> <br /> <br />