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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. NO. <br /> 220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />, own or occu,~ CODE-A-PHONE: 588-7904:84HOUR <br /> <br />TYPE: ON~S!TE SEWAGE <br /> <br />PERHIT 0R APPLICATION <br /> <br />(,BI,TRAL ~0,.,. NfL <br /> <br />SANE <br /> <br />~:'HONE:: 769-77J4 <br /> <br />WATER,~UPPLY: P~ <br />TEST HOLES READY[ <br />SITE EVALUATION NUN2ER; <br />EXISTING TANK .,i.E, <br />~IaTilqG ~RAiN ~'IEL, D LINES: <br />S~PTIC TANK ~UMFE~ <br />PREVtDU~ ND. BEDRDOMSr 4 <br /> <br /> TOTAL AS$1a~SED FEES <br /> PREVIOU~ RECEIPTS <br /> H - ,- .. , * ,., ~',(:L o~,~ <br /> T IS RE~IPT <br /> <br /> , v - ,, " BALA!qCE DUE' <br /> ~A SIS: IR:' ~ ~ax"~'r .., ...;, , ,/ <br /> ' ........ ...., ES~E,¢,.~, NB_~,a":~. ' ','" .. ~ <br /> R~C~ i~¢ED ~.~Y- . .... <br /> <br /> S~:E A'I'TACH~:I) DOC ~MENI' FOR 'R~GUIR~MENT~ OF O~-~iTE SEWAGE' <br /> <br />&t..[.. ' '.-e.~ TH4T <br /> ,fix E,..,$,,R ¢ !NFOR~ATZCtq HA8 BEEN P~OVIDED. <br /> <br /> <br />