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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. ~ <br />320 HIGH STREET NE <br /> SALEM. OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 PM. * 8 00 A,M <br /> <br /> 02/2'//89 TIME: <br /> <br />~,Tu~ ~x~SEN 0 DALLAS <br /> <br />~¥ RE~[ DENTIAL <br /> <br /> 9223 9233 H STAYTON RD <br />4~J~VILLE ~ <br /> <br />97325 <br /> <br />PHONE: '~49-10~g <br /> <br />SITE NUIV~ ER: 6622 <br /> <br />MAP <br /> <br /> 1 <br />~'.$1000 <br /> <br />TYPE: <br /> <br />P~'Ht~T OR APPLICATION NO: <br /> <br />J ENSEN, DALL.A5 <br />PHONE: <br /> <br /> [ TEN <br />ANNUAL EVAL. - TENP OR H0~HP MH <br /> <br />9014205 <br /> <br />PAYEE: REEOE. EL.M~R <br />RECEIVED <br /> <br />t~ATERSUPPLY: PN <br />TEST HO[?~ RE, AOY~ <br />SITE EVALUATION NU~ER, <br />EXISTING TANK SIZE: 1000 <br />EXISTING 0RAIN F~ELD LINES: <br />SEPTIC TANK PUMPED: GIVEN FC)R~ <br />PREVIOU~NO. gEORQOF~: <br /> <br />QUANTITY <br /> 1 <br /> <br />TOTAL AE, E, ED;~ED FEES <br />PREVIOUS RECEIPTS <br />TH~ RF. CEIPT <br /> <br />SALANCE DdE <br /> <br /> RECEIPT NO: <br />TYPE.' CK CHECK #-~ <br /> <br /> AMOUNT <br /> SS0.00 <br /> $60.00 <br /> $0.00 <br /> $60.00 <br /> <br /> $0.00 <br /> <br />15048 <br />2003 <br /> <br />SEE ATTACMED IDOCUIv~NT FOR REQUI'RB~IENTS OF ~',I-$ITE S~ SYSTEM. <br /> <br />ALL NEC~ IN~TI~ <br /> <br />CITY JURI,~DICTIQN: BY ....... DATE_ <br /> <br />PL.~N ~VIE~N: 8Y ,~ <br />REMARKS, HD~P AUTH <br /> <br />~,~,~c~-:~ ~.v.~ OFFICE COPY <br /> <br /> <br />