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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: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I al~ a registered builder OR ( ) the authO¢l=ed representative <br />OU~er <br /> <br />SIGNATURe Og A~LICANT: ........................ <br /> <br />TYP~: 0N-SiTE ,SEINAGE <br /> <br />PER~IT' OR APPLICATiON NO: 39583 <br /> <br />CONTRACTOR~.. NO. . : <br />MP. SiLA, LCU <br />9003 ,SHAN ,SQUARE RD 5~ <br />AU~SV[LLE <br />PHON[:. 749-1011 <br /> <br />WATER SUPPLY: PW <br />T6ST HOLES READy= <br />6[TE EVALUATION NUi~IBE~: <br />'EXISTING TANK 5[ZE: 1000 <br />EXi~T[N~ DRAIN 'P~ELD L[NES: <br /> <br />PREVIOUS NO. 8EOl~Jolv15: <br /> <br />E×ISTJNG ~Y'STEM ~V'AL. RPT. <br /> <br /> TOTAL ASS~ED <br /> PREVIOUS RECEIPTS <br /> THIS R~CEIPT <br /> <br />~TJANTITY <br /> <br />AMOUNT <br /> <br /> ~130.O0 <br /> 130.00 <br /> $o.oo <br /> <br />BALANCE DUE SD. O0 <br /> <br />PAYEE: RECEIPT NO: <br /> <br /> RECEIVED BY: pb2 TYPE.- - ~I'IE:CK ~*- O <br /> <br /> SEE ATTACHED ~T ~R R~iR~TS 0F ~-SITE S~ SYST~, .. <br /> <br />~T~T[~ FAJG TO E ~L <br />Z~I~ ~1~0~, THIS ~IT <br /> <br /> RE~/kRKS-. EXISTING SYSTEM E~VAL FOR PARTITi~ING ~I~TING <br /> ,. ., . L~T~ TO ~RR~T ~L~. 5E~ R~iSEO PLOT <br /> ~ALD~E. ~DLEY, ~RI~ ~NTY BUILDING OFF1Ci~ <br /> <br />.~ ~ uc ~ .~v. ~ OFFICE CO~ <br /> <br /> <br />