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MARION COUNTY BUILDING INSPECTION <br /> SENATOR SLDG, NO. 225 <br /> 220 I~iGH STREET NE <br /> -- SALEM, <br /> <br /> PHONE; ~8-5147 8:~ - 4:30 <br /> 24 HOUR CODE-A-PHONE: ~-79~ <br /> <br /> I am a r~istere~ buH~er OR ( ) the ~u~horlzed resresantative <br /> <br /> Other <br /> <br /> DATE: 10/J, 6/92 TIME: <br />6WNER: .................................................................... " <br />; HORRISON, RONALO SCilSOOO <br /> <br /> ~844 KEENE LN SE ................................... <br /> <br /> S~YE NUHBER: 92-0~697 <br /> PHONE: 749-~018 V~LU~T[0N: <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NO. <br />HORRISON~ RONALD <br />SAHE <br /> <br />PHONE: 749-1018 <br /> <br />9045267 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING ORAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BECROOHS: 2 <br /> <br /> ITEM QUANTITY AMOUNT <br /> AUTHORIZATION NOTICE - FLD'. VISIT 1 $150_00 <br /> TO~AL ASSESSED FEES $130.00 <br /> 'PRE'VIOU~ RECEIPTS $0-0o <br /> THIS RECEIPT ... $130,00 <br /> BALANCE DUE <br /> PAYEE: MOREISON. RONALD RECEIPT NO: 45348 <br /> RECEIVED BY: CL ............... TYPE: CA CHECK ~: 0 <br /> SEE ATTAOHEO DOCUMENT FOR REQUIREHENTS'OF ON-SITE SEWAGE SYSTEH. <br />* THIS IS NOT A PERMIT. THIS APPLICATION HUST GO THROUGH,~ REVIEW PROCESS WHERE THE <br />FOLLOWING MUST 8E COMPLETEO. IT IS THE RESPONSIBILITY OF THE APPLICANT TO A~SURE THAT <br />ALL NECESSARY ~NFORHATION HAS SEEN PROVIDED. <br /> <br />PLAN REVIEW: ....... A E___~~? CITY JURISDICTION: 8Y <br />~EMA~K$: AUTH <br /> <br />, DATE ............ <br /> <br />OFFICE COPY <br /> <br /> <br />