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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG,, NO 225 <br />2-20 HIGH BTREE'f NE <br /> BAL6M, OREGON 97301 <br /> <br /> PHONE:588-5147 8:00- 4:30 <br />24, HOUR CODE-A-PHONEt 588-7904 <br /> <br />HOLCU~EK,R(~ERT <br /> <br />TYPE <br /> <br />90221-150 <br /> <br /> 20O "-2,ANT[AM AVE <br />DEIROiT <br /> <br />OR 97342 <br /> <br /> CONTRACT CiTY <br /> <br />DETRO i I <br /> <br />NO <br /> <br />2150 34TH AVE NE <br />~LEM, OR 97303 <br />~(~E: 363-5578 <br /> <br />SiT~ NUt, ER: <br /> VALUATION ~ <br /> <br />12674 <br /> <br />MAP <br /> <br />50 150 <br /> <br />5F <br /> <br />~O NO <br /> <br />I YPE." ON-SI <br /> <br />PEI.~IZT OR APPLiCAtiON NO: 31578 <br /> <br />CON['RAC[O~, NO. <br />HOLC~JBEK,ROf¢E~I <br />2150 $4FH AVE NE <br />5ALFJ~, OR 97303 <br />PHONE: 363-5578 <br /> <br />NATERE~JPPLY= CN <br />TI~ST HOLE~ READY~ <br />SiTE EVALUATION <br />EXiSTZNG TANK SIZE: 550 <br />~I~TING O~IN FIELO <br />~EPTiC 'T~K ~MPED: <br />PREMISS NO. BEO~: 0 <br /> <br />AUTHORIZ. ATiON NOTICE - PLO. Vi~iT <br /> <br />~A!._N~CE L~JE <br /> <br /> QUANTIFY A.~OUNt <br /> 1 $105.00 <br /> <br />TOTAL AEx~SED FEE.~ $105.00 <br />PREVIOUS RECEiPm $105.00 <br />~l~ R~Ej PT $0.00 <br /> <br /> $o.oo <br /> <br /> 0 <br /> 0 <br /> <br />PAY&E: iNVOiCE. NO: <br />RET~E.[VED BY= CL TYPE: CHECK <br />SEE AITACHEO ~DOJ~T ~'OR RE(~IRE~ENTS O~ ON-SITE SEWAGE <br /> <br /> ~ THi.~ IS A VALID PEt~IT <br />~ST~TZ~ FA[~ TO <br /> <br />RFJVlARK~; AUTH - FIELD CHECK <br /> <br />OONALD E. VCOODLEY, MARiON COUNTY BUILDING OFFICIAL / BY ....................................... <br /> <br />~oRu ,*uc ~s s~n~ ,..~ OFFICE COPY <br /> <br /> <br />