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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: 588-514,7 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> I am a regi~toYod 13ullder OR ( ) the avthorized rep~eo~tadve S~GN~TUR~ OF APPUC~:_~ ................ ~ ~ ....... <br /> this dooum?nt. --~ ~ <br />?Wfl'~', .,D~.TE~..~4v:);g/.?~ ........ T,~¢JE.~.,, ~'35=-'~ ................ ~.-~-[0~ ........................... [gA'*~-~v; <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />Lf. Lql.~Ef,TOR~ ,.0,. <br />SELEEN~ JANET <br /> <br />PHONE:: 749-iS87 <br /> <br />704~418 <br /> <br />WATEE SUPPLY:' PW <br />TEST ~OI..E.~ READY: <br />~iI'E ~,VALUATIO;4 I,fU~i~ER: <br />EXtOT~N6 TANK ~iZE: <br />~XISTZN~; D~AIN FIELD LINE.>,, <br />SEPTIC TANK PUNPED= 4/7/93 <br />PF~EVIOUS NO. BEDROOMS: ~ <br /> <br />ITEH <br /> <br />AUT.{OR;EZA'¥zoN , O¥,,(.E - NO VIS:Fl' <br /> <br /> TOTAL A~SESSED FEES <br /> F',r'<EV[ OUS RECEIPTS <br /> .THIS RECEIPT <br /> <br /> BALANCE DUE <br /> <br /> PAYEE',~ SEL. EE{% JANG'F ,.~ ' RECFiPT NO: 48655 <br /> <br /> ~,,~:, ~"FTA[J..t~:D DOCUMENT FOR RE~UI~EMENT~ OF ON-SITE SE~gg SYS3..M. <br /> <br /> ....... ,.,U~9rUt_;..,a/, I, ,~, ,'H. R=S ONBi~IL~TY OF THE APPl ICAR'F TO ASSUR:: THAT <br />ALL l,c. LE.f~f~hR~ iNFORmATION HAS ~EEN PROfIDED. <br /> <br /> <br />