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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLD~G, NO 225 <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 />11/01/89 <br /> <br />TAX LOT: <br /> <br />.OIETRZCH o,, GEORGE & NOLA <br /> <br />CONSTRUCTION T~PE <br /> <br /> 10577'~B~ STAYTCN RD <br />AU~V i LtLE OR <br /> <br />97325 <br /> <br />.... NO' <br /> <br />SANE <br /> <br />PHONE-. 769-2?07 <br /> <br />SITE NUI~IBER= 9745 <br /> <br />· : ,, ,NO,,,,, .... ;,,,,,,,N,,,O ......... <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PER,lIT OR APPLICATION NO= <br /> <br />CONTRACTOR, NO. 34916P-2 <br />STAYTON NILL CITY SILVERTON <br />41155 STAYTON ~CIO DRIVE, SE <br />STAYTON. OREGON 97383 <br />PHONE: 769-2302 <br /> <br />NATERSUPPLY: <br />TE~THOLES READY: <br />SITE EVALUATION NUNBER= <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINE~: <br />SEPTIC TANK PUMPED= <br />PREVIOUS NO. 8ED~OCtw~: <br /> <br /> ITEN <br />REPAIR - ~kJOR <br /> <br />TOTAL A,.~ESSED FE~ <br />P~=-VIOU$ RECEIPTS <br />THIS REOEI PT <br /> <br />QUANTITY AMOUNT <br /> $80,00 <br /> $80~00 <br /> $o.oo <br /> $0.00 <br /> <br />DUE $80.00 <br /> <br />PAYEE: ~'~ RECEIPT NO: <br />RB~EIVED BY: PR~."1~..~ TYPE; CHEX;;K ~: <br /> ~A~ ................ <br />SEE A ED ~T ~R R~I~ OF ~ITE ~E ~T~. <br /> <br />PLAN REVIEN: BY_____ DATE ...... <br />REMARk: 1,4,a~JOl~ REPAIR TANK & ORAINFLO <br /> <br />CITY JURISDIC~TION: BY <br /> <br />{SENT OK BACK TOO Iv~UCH <br /> <br />0ATE <br /> <br />OFFICE COPY <br /> <br /> <br />