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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: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />DATE: 01/:L~/93 ~IME..: 10:2~:,02 ...... <br />BURLEIGH, ~AMES & LECTA <br /> <br /> li952 STEINKAMP RD SE <br />~UHSVILLE OR 97525 <br /> <br />PO BOX'lSI02 <br />PHONE: <br /> <br />SIGNATURE OF ApPL CAN¥ ............ <br /> <br />DATE! ....... <br /> <br />· TA~ LO~: · CAT[GORY: <br />: 56510946 RESIDENTIAL <br />! ¢ON$¥AUE'nO~ ~Y~E: oCCUp~.C¥: <br /> <br />M~RIO~ OOU~TY ~.,NO" ' <br /> <br />....................... <br /> <br />666 i AC NO NO <br /> <br />TYPE: ON-BiTE SEWAGE <br /> <br />PERMIT OR APPLICRTION NO: <br /> <br />CONTRACTOR. NO. <br />BURLEIGH, 3~MES & LECT~ <br />PO BOX 18102 <br />SALEM ~7~05 <br />PHONE: ~95-8790 <br /> <br />44620 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: 77-i909 <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD L~NES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> I TEN ~UANT I TY AMOUNT <br /> STANOARO ON-SITE SYSTEM i $210.00 <br /> <br /> TOTAL ASSESSED FEES $210.00 <br /> PREVIOUS RECEIPTS $210. O0 <br /> THIS RECEIPT $0,00 <br /> <br /> IBALANCE DUE $0.00 <br /> <br /> PAYEE: <br /> RECEIPT NO." <br /> RECEIVED BY: PH TYPE: CHECK ~: 0 <br /> <br /> SEE ~TTACHED DOCUMENT FOR REQUIREMENTS OF ON-SITE ~EWRGE SYSTEM. <br /> <br />* T~IS IS A VALID PERHIT · TH[8 PER~IT EXPIRES ~60 OAYS FROH ITS ISSUE ORTE. IF <br />CONSTRUCTION FAILS TO MEET RLL <br />ZONING ORDINANCES, THIS PER~.IT SHAkL BECOME NULL AND VOID. <br /> <br />REMARKS: STANDARD SYSTEM - CONSTRUCT THE DRAINFIELD$ AS FAR UPSLOFE}.AS.~. POSSIBLE. <br />DONALD E. WOOOLEY. MAR~ON COUNTY BUILDING OFFICIAL / 8Y ..................... <br /> <br /> <br />