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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLIDG, 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 />OWNER; <br /> <br /> 11704 DITTER DR <br />USE dF OU,¢~CAIMSV'ILLE ............ DR <br /> <br />CE <br /> <br />2885 BW 224TN <br />HYLLSBORO~ OR ~/7123 SI'rE HUtIBER: ?3-01748 <br />PHONF-C_o65,<~'9-7~B7 SECTION: 'I'OWNShI'P; ~'~''¢'9N=~ ~'d~J~: ' ' MAR: <br /> <br />28 88 1W AR 48R <br /> I..'-; AC NO NO <br /> <br /> TYPE: ON-SITE SEWACE WATER SUPPLY <br /> TEST HOLES READY: <br /> PER~IT OR APPLICATION NS: ?1it47212 SITE EVALUATION NUHBER: <br /> EXISTING TANK SIZE: <br /> 60N'FRACTQR. NO, ~ ~ EXISTIN6 DRAIN FIELD LINES: <br /> LOR~, DOUG ~ ,t~.~ I~[ ) SEPTIC TANK F'lJ~PED: <br /> 288~,~W 224TH ~,~.~.~.~\~,)v~,~.~ PREVIOUS NO. <br /> <br /> PHONE: 64~-73m7 ,,C~-~".'~,~~ ' <br /> ITEW ~UAW'fZTY AMOUNT <br /> EXISTING SYSTEM EWL. RPT, ~ <br /> TOTAL ASSESg~D F~ES <br /> PREVIOUS RECEIPTS <br /> THIS RECEIPT <br /> <br /> BALANCE DUE <br /> PAYEE: RECEIPT <br /> RECEIVED BY: cI TYPE: CHECK ~: <br /> SEE ~TT~CHEb ~OCUNENT Fg~ REgU~EE~ENTS OF 8N-~TE SE~6E <br /> <br /> ¢ THIS IS NOT A PERHIT, THIS APPLICATION HUST ~ THROUGH A REVIEW PROCESS WHERE THE <br />FOLLOWING MUST BE CONPLE%ED, IT IS THE RESPONSIBILITY OF TH[ APF'L~CANT TO ASSURE THAT <br />ALL NECESSARY IHFORHATZON HA~ BEEN PROVIDED. <br /> <br />PI. AN REVIEW: BY DATE <br />REMARKS= ESE HOLD: PF <br /> <br />C~T¥ JURISDICTIOH: <br />(BAL, DUE) <br /> <br />BY .................. DATE .................... <br /> <br />OFFICECOP¥ <br /> <br /> <br />