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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG NO. 225 <br />220 HIGH STREET NE <br /> SALEM. OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />SIGNATURE OF APPLICANT <br /> <br />5991 [,.~AL[NA COURT <br /> <br />8830 ,~JNSET WAY <br />~ URNER, OR 9?392 <br />PHONE: 74-3-2723 <br /> <br />ROLLING GREEN E~TAT~ <br /> <br /> SITE NU~IBER: 10586 <br />:'B~CTI~Ni :~OWN~HIP:: RAN~UATiO~:~ON~ MAP <br /> <br />IYPE: ON-SI'rE SE~-'~,GE j HATER ~SUPPLY: P~ <br /> TI~ST HOLE.~ R~DY: YE8 <br />PE~iT OR APPLICATI~ NO: 9025358 ~[TE EWALUAT[~ NU~ER~ <br /> EX[STING T~K SIZE: <br />~f~rOR, NO. ~ISTING D~IN FIE~D L~N~: <br />S~UTHE~T, PIXAR0 I SEPTic ~K <br />68~0 ~N~ET HAY . ~ ~ ] ~[~3 NO. <br /> <br />...... ;7[7 .......... ...... <br />SiTE EWA~AIJ~, EA, ADDL. LOT ~ : 1 $145.00 <br /> <br /> ~" TOTAL ~ED FE~ $145.g~ <br /> -PRizeS ,R~E~PT~ $0. O0 <br /> TH15- ~ECE~PT $145_ DO <br /> BA~CE ~E $0. O0 <br /> <br />PAYE~: S'fU[HEI~, RI~ARO RECEIPT NO: 26857 <br />RECEIVED BY: ~2 .............. . ...................... IYPE: CK ~ECK ~: 149 <br /> <br />~EE A~ ~AC~ED ~M~T FOR R~[~R~TS OF ~-SiTE S~GE sYs'r~. <br /> <br />NOTE: THiS 00E~ NOT GRANT OR II, PLY PER~I[~ZC~I TO E~JIL~ ON ~H18 P~EL. P~ING ~O <br />~T~CTI~ P~I~T BE ~TAiN~ B~O~ BUiLDiNe ~ ~TJC [~T~T[m <br /> = <br /> <br /> ~E~RKS: SITE EVALUA1 i~ <br /> <br />OFFICE COPY <br /> <br /> <br />