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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. NO. 225 <br /> 22.0 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 P,M - <br /> <br />WOOLSEY, OUANE <br /> <br />~:~ I DENTI AL <br /> <br /> 11457 MCCLELLAN RD <br />AUh~VI LLE OR 97325 <br /> <br />SAME <br /> <br />PHONE~. 749-15'/3 <br /> <br />CONI~TRUGYIO N TYP~. <br /> <br />SITE NUIV~ER ~ (~ <br />VALJJAT I ON: <br /> <br /> ,~X~OUPANT L~ <br /> <br />LOTS ~-~ <br /> <br />PERNIT OR APPLICATIC~ NO: <br /> <br />CONTRACTOR, NO- <br />~OOLSEY 0 [~JANE <br /> <br />PHO~qE: 749-1573 <br /> <br />TE~T HOLES RE. ADy: <br />~[TE EVALUATION NLIN~ER; <br />EXISTING TANK SIZE: 350 <br />~ISTING D~IN FIELD LIN~ <br />SEPTIC T~K ~NPEO: 4-~-88 <br />P~I~S NO. BED~: ~ <br /> <br /> [Tm <br />AU'P~ORIZATION NOTICE - FLD. VISIT <br /> <br />PAYEE: <br />RECEIVED BY: CL <br /> <br />(~JANT~TY <br /> <br />TOTAL ~ESSED FEF_~ <br />PREVZO/J~ RECEI PT~ <br />THIS RECEIPT <br /> <br />BALANCE DUE <br /> <br /> RECEIPT NO: <br /> TYPE: OHECK <br /> <br />SEE ATTACHED ~T FoR RI~XJI~'flENTS <br /> <br />~o.oo <br />~O.O0 <br /> <br />REMARKS: AUTH R~97~8 <br />[XDNALO E- NDOOk85', MARI~ CCXJNT¥ 8UILDIN80P~!CIAL / 8Y _____~~.~=w~ <br /> <br /> <br />