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220 HiGH STREET NE <br /> SALEM, OREGON 97501 <br /> -~ <br />PHONE 588-5147 <br />CODE-A-PHONE 4:30 P,M. ' 8:00 A.M. <br /> <br />.,DATE-* 08/25/$8 TIME: 9~09=~3a. <br /> HERREN, TRESSI E <br /> <br /> 12475 FEY RD <br />AU~PA oR 97002 <br /> <br />LOT <br /> <br />515 117 <br /> <br />SIGNATURE O~ APPLICANT' ...... <br /> <br /> ~TTE NUMBER: 5180 <br /> VALUATION: <br /> <br />60265.0 ~ SF NO <br /> <br />10392 <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PE~IZT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />HERREN. TEES,G I E <br /> <br />PHONE: <br /> <br />NATER ,~JPPLY= PW <br />TEST HOLES READY: . <br />SITE EVALUAT~ONNUF~BER. <br />EXISTING TANK ~ZE: 1000 <br />~[STING D~IN FIELD LINE~= <br />S~TIC T~K ~= CK IN 86 <br />PR~]~ NO. BED~: 2 <br /> <br /> ITE~ <br />AUTHORIZATION NOTICE i NO VISIT <br /> <br />TOTAL: ASS~D ~.EES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />QUANT~'TY ANcxJNT <br /> 1 $80.00 <br /> <br />~80,00 <br /> 60.00 <br /> $o.oo <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: RECEIPT NO: <br />RECEIVED BY: CL TYPE: CHECK <br /> <br />SEE ATTACHED DOCUI~IT FOR ~REQUTREN~q-$ OF ON-SITE S~E <br />~ ~18 IS A VALID ~IT ~ ~IS. ~IT ~IR~ 360 <br /> ~C~, ~[S PE~ZT ~ B~E NULL ~D <br /> ~D <br /> <br />RSvLARKS: AUTH k~ 4000 <br /> <br />DCNALD E. NOODLE'Y. I~ARION COUNTY BUILDING OFFICIAL / DY <br /> <br />OFFICE COPY <br /> <br /> <br />