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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 />08/30/91 T i t"lE; 16:15.'55 <br /> <br />SIGNATURE O~ APPLICANT <br /> SATE <br /> <br />RESlDEN <br /> <br /> 8144 AUMSViL.LE HNY ~E <br />AUt,'r-sviLLE OR 97~5 <br /> <br />MARION C.~UN TY NO <br /> <br />8OX 13611 <br />C~ALEM OR 97309 <br />PHON~: 581-2767 <br /> <br />1'/ <br /> <br />5.64 <br /> <br />[YP~: ON-SI'I"E Sk~3E <br /> <br />PERf, llr OR APPLiOATiON NO: 54635 <br /> <br />CON IRAC~OR, NO. <br />MOk1¢AN, RON <br />~OX 13611 <br />SALEM OR 9'7309 <br />PHON~: 581-~76'/ <br /> <br />SANT 1AM MEA~ <br /> <br /> VALJJAFION= <br /> <br />8S 2W AR <br />AC NO NO <br /> <br />WATER ~SUPPLY: PW <br />rESf HOLD. T5 READY: <br />SiTE EVALUATION NU~ER: 315~ <br /> <br />SaPTiC T~K ~MPED: <br />RREWI~S NO. 8ED~: <br /> <br />5'1 <br /> <br /> iIEM QUANTITY Ar, K~N? <br />GE < 5 IVIONTHS OLD l $110.00 <br /> <br />TOTAL AS~P-~ED FEES <br />PREVIOUS RECEIPTS <br />THIS RECEIPT <br /> <br />~119.00 <br />llO.O0 <br /> SO.00 <br /> <br />SALANCa DUE $0.00 <br /> <br /> PAYEE: RECEIP] NO: <br /> R~CEIVED BY: 0~42 tYPE: CHECK ~: 0 <br /> $~E AYIAL,,'tHED DW. lCUME~T FOR RE(~JIRENE}ITS OF ~itE S~E SYST~. <br /> <br /> ~ THIS 15 A VALID P~IT * ~l~ PE~IT ~PI~ 360 ~ F~ l~ I~E DATE. IF <br />~T~I~ FAI~ TO ~T ~L ~~ OF STATE ~ ~D ~I~ ~TY BUI~ING ~O <br /> <br />REMARKS: NEW SEP'TiC R~2557 <br /> <br />L,v-.,)NALO k. I,~JODLEY, MARION COUNTY BUILDING OFFICIAL / BY <br /> <br />FC~:~M ~ MC 15'5~ REV 4~ OFFICE COPY <br /> <br /> <br />