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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HiGH STREET NE <br />SALEM, OREGON 97301 <br />PHONE: 588-5147 8:00- 4:.3;0 <br />24 HOUR CODE-A-PHONE: 588 7904 I ~.. <br /> <br />WATER ~UPPLY~ PW <br />TEST HOLES RE:~Y: <br />SITE EV~LU~T.I, ON NUHBER'~ <br />EXISTING TANK ~[E: [7~ <br />EXI..T[N& 9RAIII FZEI,.D LINES; <br />SEPTIC TANK PUMPED: I..,,2¢-9.~ <br />PRFVIOU~ NO. ~K~l:~OC)~lS~ 2 <br /> <br /> t T'F.H QUANTITY AN[1UNT <br />AH'IH(IRITATTDN NOTICF -, FLD. VIgil' ,~ $I614.00 <br /> <br />· PREVIOUS R~BEIPT~ <br /> THIS RECE~P'i' <br /> <br />$160.0o <br /> <br /> -ALEE. WII.,I,.1,~H~ON~ ROBERT & ELI~A.~ETH RECI~,~.P'' I,)O: 47916 <br /> R~[~IVF~ 7~Y: P~ ............................................. TYPE~ CI< [.~H~[;i~ ~: 3.146 <br /> <br /> ~E&" A~ ~CHR[ ~O(.LIHFI,IT FOR R~QU[REbI~NTS <br /> <br />POI,,L,O~N~ HUST BE CO,PLE~I~., ~T IS THE RESPONSiBiLITY OF <br />A,L. NI:.LESSARY INFORHATI[I)4 HAS BE~N PROVIDE~. ' <br /> <br /> _3 <br />RFNARKS~ AUTH F'IELD VI~,TT <br /> <br />C'[TY ,JURI~U)((Yt'~ON~ ~gY ................... OATE ..................... <br /> <br />OFFICE COPY <br /> <br /> <br />