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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: S88-5147 8',00 - 4:.30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />SIGNATURE O~' APPLrCANT: ...... <br /> <br />· bWN,m.. DATE~ 0~1~2193 <br /> 'srrus ^D~F.~D/HL~ LOUISE <br /> <br />TIHE; <br /> <br /> :~2122 FRY ROAD <br />us~, o~ eu,~O~RORA' <br /> <br />MAR'CDOR-COUNTY' '"'NO" ' <br /> <br />MAP; <br /> <br />PERHI~ OR APPLICATION <br /> <br />CONTRACTOR~ NO. <br />LOFDANL~ LOUISE <br /> <br />PHONE~ <br /> <br />454a2 <br /> <br />WATER SUPPLY <br />TEST HOLES READY: <br />~TE EVALUATION NUMBER~ <br />EXISTING TANK SIZE: <br />EX~STING DRAIN FIELD LINES; <br />SEPTZC TANK PUMPED: <br />PREViOus NO, ~EDROOMs= <br /> <br /> ITEM QUANTITY AMOUNT <br /> ANNUAL EVAL. - TEMP OR HDSHP MH <br /> <br /> TOTAL ASSESSED FEES $98.80 <br /> PREVIOUS R~CEIPTS $98.80 <br /> THIS RECEIPT <br /> <br /> BALAN6E DUE $0.00 <br /> <br /> PAYEE~ REOEZPT NO: <br /> RECEIVED BY: PB .......................................... TYPED 6NECK ~: 0 <br /> <br /> SEE ATTACHED OO~UMENT ?OR REQUIREMENTS OP ON-~ITE SEWAGE ~YSTEM. <br /> ~ TNI~ IS A VALID PERMIT $ THIS PERMIT EXPIRE~ 36B DAYS FROM ITS ISSUE DATE, IF <br />CONSTRUCTION FAILS TO MEET ALL REQUIREMENTS OF STATE LAWS AND MARION COUNTY ~UILDIN~-AHD <br />~ON~N6 ORQ~NANCES~ TI,,IZS PERMIT SHALL BECON~¢ NULL AND VOID. <br /> <br />REMARKS: <br /> <br />~)ONAt,D E. <br /> <br />ND~;P RENEWAl. <br /> <br /> ~.gOOl)l. EY~ ~ARION COUNTY BUILDING OFFICIAL / BY <br /> <br />OFFICE COPY <br /> <br /> <br />