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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HtGH 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 />IOIlseeds- ~0 Ihe-~erm~ s~tod on ~he rever~e e~(le o <br /> <br />SIGNAtUrE OF APPL CAN't ............ <br /> <br />..................... ,'~AX'L6f: .......................... <br /> <br />i o~B~T~NT I At_ <br /> <br />gALE~ OR 9730~ ~ITE NUt,ER: <br />PHONE~ 363-6~18 VALUATION: <br /> <br />TYPE: 0N~SITE SEWAGE <br /> <br />PEEMiT OR APPLICATION <br /> <br />~ONTRACTOR~ NO. <br />SHADER. DANIEL E. <br />71~ EWALD AVE SE <br />SALEM DR 97302 <br />PNOflE~ ~83-6518 <br /> <br />WATER SUPPLY.: F'W <br />TEST HOLE8 REAOY: NO <br />~ITE EVSLUATION ~UM~ER: <br /> XISTIN~ TANK <br />EXISTING DRAIN FIELD I. INES: <br />BEPTI~' TANK PUMPED: <br />PREVIOU~ NO. BEDROOMS: <br /> <br /> ITeM gU~N?[TY ~MOUNT <br />SITE EVALUAT~OI% EA. ~DDL. LOT I $22~,00 <br /> <br /> TOTA'L A~SES~ED FEE~ '225.00 <br /> <br /> BALANCE DUE $0,00 <br /> <br />PAYEE~ RECEIPT NO: <br />RECEZVEO ~Y: PB 'fYP~. CHECK ~: 0 <br /> <br />SEE ATTACHED DOCUMENT FOR REQUIREMENTS OF ON-S~TE SEWAGE SYSTEM~ <br /> <br />NOTE.' THIS DOEg NOT GRANT DR IMPLY PERMISBION TO BUIL~ ON THIS PARCEL. PLANNING AND <br />ON~TRUCTION PERMIT.~ MUST ~E O~TAINED BEFORE BUILDING OR 8[:,:PT]]C INSTALLATION BEGINI~. <br /> <br />REMARKEi." <br /> <br />])ONALI) E;. <br /> <br />SITE EVAI_UAT[ON LOT 1. STANDARD SYSTEM WITH CURTAIN gRAIN. <br /> <br /> WD(')DLEY., MARION COUNTY BUILDING OFFICIAl.. / BY ............................. <br /> <br /> OFFICE COPY <br /> <br /> <br />