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MARION COUNTY BUILDING INSPECTION <br />SENATOR 8LOG. NO- 225 <br />220 HIGH STREET NE <br /> SALEM. OREGON 97301 <br /> <br /> PHONE: 588~147 8:00 - 4:$0 <br />24 HOUR CODE-A-PHONE: 5~8-7904 <br /> <br />The work will be ;~erformed bY a regk~ eted bu der. <br />I have rea~ ~n~[ sgree to the terms "t~te~ o~ tbe'revers~'"~Jde of <br /> <br />...................................... <br /> <br />,~AME <br /> <br />F'F(~:tNE ~ 7&~-'77~4 <br /> <br />VALUATION: <br /> <br />TYPE,' ON-SITE SEWAGE <br /> <br />PERHTT OR APPLICATION NO,' <br /> <br />CDNTRACTDR~ NO. <br />t{~F< ESI~E,~ EUGENE <br />SANE <br /> <br />PHOebE: 769-7754 <br /> <br />W&TER SUPPLY: PW <br />TEST HOLES REA~Y~ <br />SITE EVALUATION NUH~ER~ <br />EX~$TIN6 TANK SIZE= <br />EXISTIN~ ~IN FIEL~ <br />SEPTIC.TANK <br />PREVtObS NO. FEDROOHS~ <br /> <br /> tl'g~f OUANTI'FY AMOUNT <br />A[JTHO;~IZATION NOTICE - F'L.D. VZSIT <br /> <br /> TOTAL ASSESSFD FEES <br /> <br /> BALANCE DUE ~0. <br /> <br />I A(E~:. RgCEiPT <br />R~CEZVEg ~Y: PB ......................................... TYPE: t~HECK <br /> <br /> THIS IS A VALID PERMIT ~ TM~9 PERmiT EXPIRES ~68 DAYS FROM iTS ISSUE ~ATE, If <br /> ~ U~L~,[hIG AND <br /> <br />I .,..MAR,~,.~. A U'I'H <br /> <br />OFFICE COPY <br /> <br /> <br />