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MARION COUNTY BUILDING INSPECTION <br />SENATQR BLDG, NO, 228 <br />· 220·RfGH 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 />have read and agre~ ~o the term?'stated Otl"{he revC:~'S¢, ~ld~-'~ <br /> <br />DATE: 08/3i/~2 <br />...................................... T f~ L,b'r? .................... <br /> <br />HILLER, <br /> <br /> ~50 BREITENBUSM <br /> OETROIT OR <br />b¢~-~¢,,,~i~r~: .......... <br /> <br /> PO BOX 52~ <br /> DETRO~T~ OR 97~42 <br /> PHONE: 854-¢42~ <br /> <br />SITE NU~BE~: <br />VALUATION; <br /> <br /> ~, NO , NO <br /> <br />TYPE~ ON-SITE S~WASE WATER SUPPLY: CW <br /> TEST HOLES READY: <br />PERHIT OR APPLICATION NO= 9042~$ SITE EVALUATION NUMBER: <br /> EXIgTIN8 TANK SIZE: <br />CONTRACTOR, NO. EXISTING DRAIN FIELD LINES: <br />~ILLER, THOMAS & HAR~NA SEPTIC TANK PUMPED: <br />Po BOX 525 <br />OETROIT, OR 97542 i PREVIOUS <br />PHONE: B54-34~ <br /> <br /> ITEM QUANTI'FY AMOUNT <br />STO ONSITE SYS < 1000 .CAE,,' %:... i $20o.00 <br /> · '~'" '¢OTA'L'ASSESSED FEES $200.00 <br /> ' ' 't~RI~.VTOUS RECEIPTS $0.00 <br /> ,. " TH~S RECEIPT $200.00 <br /> 8'ALANOE DUE $0. O0 <br /> <br /> MARINA INVOICE NO: 44298 <br /> PAYEE: M~LLER, THOMAS & <br /> RECEIVED BY: PW ......... ~_.~_~ ._~ __~ TYPE: IN CHECK ~: 0 <br /> SEE ATTACHEO OOCUMENT FOR.REQU~REMENT~"O~ O'~TE'SEWAGE SYSTEM. <br /> ~ THIS I3 NO~ A PERHIT.' THIS'APPLiQATION MUST' 60 THROUCN A REVIEW PROCESS WHERE THE <br />FOLLOWING MUBT 8~ COMPLETED, IT IS THE RE'$PONSISILITY OF THE APPLICANT TO ASSURE THAI' <br />ALL NECESSARY INFORMATION HAS BEEN PROVIDED. <br /> <br />PI_AN REVIEW: BY ....... DATE .... CITE JURISDICTION: BY ........... CATE ........... <br /> <br />REMARKS: COML ORAINF~ELO REPAIR <br /> <br />OFFICECOP¥ <br /> <br /> <br />