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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO. ~5 <br />220 HiGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE 58~5147 <br />CODE-A-PHONE 4:30 RM - 8.'00 <br /> <br />RESIDENTIAL <br /> <br /> 1113a SIMP'iON RD SE <br />AUIV~VILLE OR 97325 <br /> <br />USE O~ <br /> <br />PHONE: 749-2'773 <br /> <br /> 50. O00O <br /> <br />TYPE: ON"~I TE <br /> <br />PERf4IT OR APPLICATION <br />CONTRACTOR, NO. <br /> <br />PHONE: 749-2773 <br /> <br />13846 <br /> <br />NATER SUPPLY: I~ <br />TE~T HOLES READY-. <br />SZTE EVALUATION NUI~ER: <br />EXISTIN~ TANK SIZE: <br />I..,XISTING DRAIN FIELD LINES: <br />SEPTIC TANK PUNPED= <br />I:~REVI~ NO. I~EDROC~$: <br /> <br /> ITEM <br />ALTERATION I <br /> <br />TOTAL. ~EO FEES <br />PREVZOU$ RECEIPT'S <br />THIS RECEIPT <br /> <br />DUE <br /> <br />RECEIPT NO: <br /> <br />N4CUNT <br /> $145,00 <br /> <br /> 3145,00 <br /> 145.00 <br /> $0.00 <br /> $0.00 <br /> <br />RENARKS; ALTERAT XON 1~6378 <br /> <br />[X:~ALD E. hOODLEY, MARZON CCUNTY 8U~LDZNG OFF~CZAL / ~Y <br /> <br />~ ~, ~ m-~ -,v ,,~ OFFICE COPY <br /> <br /> <br />