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MARION COUNTY BUILDING ~NSPECTION <br />SENATOR BLDG NO 22~ <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4,30 P.M - 8:00 A..M. <br /> <br /> have read ~nd agree to i'he terms staled on the r~veme si[ie of <br /> <br />0ATE: 04/27/8~ TIME: 9:28:47a <br /> jACk, J~ B. ~ ~ILDRED <br /> <br />TAX LOT <br /> <br />CONSTRue'rIO N ~PE <br /> <br /> 9601HOiv~)UIST RD $~ <br />AUM~¥~LLE OR 9?325 <br /> <br />PO ~OX 47? AUI~BVILLE 97325 <br />PHONE-- 749-1760 <br /> <br /> 3q <br /> <br />2?2 ocr~. 100 ~'~s~' 27200.0 <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />OEC~4IT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />JACk, JOE B. & MILDRED <br />808 SLATER <br />PO BOX 47? AUNSVILLE 9?225 <br />PHONE; 749- 1780 <br /> <br />9008118 <br /> <br />MARION C~NTY NO <br /> <br />MATER SUPPLY: PH <br />T~T HOLE~ READY: <br />SITE EVALUATION NLtMIS'ER: <br />EXISTING TANK SIZE: <br />~I~TING D~IN F[ELO LINES: <br />SEPTIC T~K ~MP~D: <br />PR~I~S NO. ~EO~= <br /> <br />PAYEE: JACKE~N, JOE 8. & MILDRED <br />RECEIVED BY: OM <br /> <br />TOTAL AE~ED <br />PREVIOUS RECEIPT~ <br />THIS REOEZPT <br /> <br /> 8AL~_~E RECEIPT NO: <br />...... TYPE: CA CHECK <br /> <br />~JANTITY AMOUNT <br /> <br /> ~35.0o <br /> SO_Q0 <br /> ~5,00 <br /> <br />SEE ATTACHED DOCUHENT FOR REJ~JlRENEN~ OF ON-SITE SElVAgE 8Y~TE~, <br /> <br />ALL NBCIBS~M~Y INFORt.4ATI~ HA~ ~EEN' PROV'fDED. <br /> <br />REPAIR tM~9854 <br /> <br />CITY JURISDICTION: BY ....... ~T~, <br /> <br />OFFICE COPY <br /> <br /> <br />