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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG, NO, 225 <br /> ~20HiGHETREETNE ,-~ i L..,,~ <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588,-5147 8:00 - 4:30 <br /> , <br /> 24 HOUR CODE-A-PHONE. 588-7904 <br /> <br />;Ow"~:KLE~N, LARRY ~ 56401000 ;RESIDENTIAL <br /> <br /> ~UHSV~LLE OR 97325 <br /> M~Z~ ~OUNTY ~ NO~ <br /> <br /> .............................. :._ .................................. ;'., ,i ................... ; <br />USE ~ aOi~D~NG: ............. ' ........ <br /> <br /> 9804 HILL CREEK RO SE ~ .......... <br /> ~UMSVILL~, OR <br /> PHONE: 749-2405 ~ VALUATION~ <br /> <br />LOT: [ ~LOCK'. ~[ON~ ] TOW~H[~[ <br /> ' I so ss <br /> <br /> ( ............. J ..........~ ...... · ; ............... ~,,..~ ...................... , ................ <br /> <br />TYPE: ON-SITE <br />PERH[T OR APPLICATION NO: 9042507 <br /> <br />CONTRACTOR. <br />KLEIN, LARRY <br />9804 HILL ~REEK RD SE ........ <br />AUMSVZLLE, OR <br />PHONE: 749-2405 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTINS TANK SIZE: <br />EXISTINQ ORAIN FIELO LINES: <br />SEPTIC TANK PUMPED: WILL 8RING IN <br />PREVIOUS NO..SEDROOMS: <br /> <br /> ITEM QUANTITY AHOUNI <br /> AUTHORIZATION NOTICE -: FLD. VISIT 1 $130.00 <br /> :' f0TAL- A S£SSE0 'F ES <br /> .. ~REVIOUS RECEIPTS $0.oo <br /> TNI'S RECEIPT · · $150.00 <br /> ............ , .-BALANCE, OUE $0. O0 <br /> PAYEE: KLEIN, LARRY ........ '"'";;~" ......... """ ; RECEIPT NO: 44576 <br /> RECEIVEO By." C! ........ ,. :,",,,,,',,,',:".~,,.i'-"";~"""':'"':':':':~'"' .......... ~.. TYPE: OK CHECK ~-" 1051 <br /> ~eE ATTACNEO OOCUNENT..FOR' REQUIREME/~.T,S, OF,'~NrS~-'TE SIEW~G,E '.SYSTEM. <br /> <br /> FOLLOWiNP~ MUST BE COMPLETED." tT I8 THE RESPONSIBILITY 'OF THE APPLICANT TO ASSURE THAT <br /> ALL NECESSARY INFORMATION NAS,BEEN PROVIDED. ' · ' ' <br /> <br /> PLAN REVIEW: B~ ~2~/f~-_ OATE~/.'~-¢e~- CITY ,TURISO.rCTION: SY <br /> REMARKS: AUTH TO HOOK TO ~XISTING SYSTEM , ' : ( ~" <br /> <br />~ OFFICE COPY <br /> <br /> <br />