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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />2~0 HIGEt STREET NE <br /> SALEM. OREGON 97301 <br /> <br /> PHONE: 558-5147 8:00 - 4:80 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />SIGNATURE OF APPLICANT: ...... <br /> DATE: ........... <br /> <br /> 0ATE: 05/0?/92 'riflE= 12:00;50 <br />OWNER: , TAX LO¥; <br /> EMERY, ADRIA~ C. JR. & J~ET E. 90250-020 <br /> <br />RE5i DEN'¥ I <br /> <br /> PATTON AOO <br />PO 80X 4;39 .' ....................... <br />AUt',,~VILLE OR 97325 <br /> <br /> VA~AT [ ~ ~ <br /> <br /> 92 17~ 16376, , SE : NO~ NO <br />TYPE: ~ITE 5E~GE ~A'[ER ~PPLY; ~ <br /> <br />pS~ll'r OR APPLICATION <br /> <br />CCNTRAC'rOR, NO, <br />~ERY, ADRi~ <br />~ 80X 439 <br />AU~V~ LLE OR 97325 <br /> <br />TEST HOLES READY: <br />SiTE ~ALUATIQN NUI~ER: <br />~XiSTING TANK SIZE: lOOO <br />E~iSTING DRAIN FIELD <br />SEPTIC TANK FUMp~Dz 08/09/91 <br />PREVIOUS NO. <br /> <br /> ITE~4 <br />AUTHORIZATiON NOTICE - PLO, ViSiT <br /> <br /> ~OTAL A,.%SEE~ED FEE.~ <br /> PREVIOUS RECEIPTS <br /> THiS RECEIPT <br /> <br /> · BALANCE DUE. <br />PAYEE: Et'IERY, ADRIAN C. JR. '& JANE~,,E[ ..: INVOICE NO: <br />RECEIVED BY: P~ ~J~_ 'rYPE: iN CHECK <br /> <br />QUANTITY AMOUNT <br /> I $130.00 <br /> <br /> $130.00 <br /> $0.00 <br /> $130.00 <br /> <br /> $o.oo <br /> <br /> 41883 <br /> 0 <br /> <br /> ~EE ATTACHED DOOJMIE~T FOR REQU~ 0F' 0N-$i~ SENATE SY~TP3~. <br />* YHIE~ IS NOT A PEt~IIT. TH[~ AI~LIOATioN I~J~B¥ GO THROU(~H A REV~LE~ PRCK~ESS ~t~RE THE <br />/;O~IN~ IVLIST BE (:3~PLI.~'TI~D. :IT. IS THE RJ~SPI:]NS~[BIL/TY. O~ THE APPLICANT TO A,,~:~JRE THAT <br />ALL NECEE~ARY INFORIWAT.[ON HAS BEEN PROVIDED. <br /> <br />OFFICE COPY <br /> <br /> <br />