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MARION COUNTY BUILDING INSPECTION <br />· i~NATOR 13LDG. NO. 225 <br />220 HtGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588.5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE:.58~-7904 <br /> <br /> DATE: 04/09/9~ TIME: <br /> <br /> , <br />~b'~'~; ......................... ' ............................. . CONSTRUCTION T~PE; . OCCUPAHCY: <br /> ~P 0.9 FOR~T SE~iC~ <br /> [~RI~ ~NTY ~ NO 160 <br /> '~¢ aOE6~N~¢ .................................................................... <br /> <br /> H~ ?~ 8~ 320 MILL CITY 97360 <br /> ~E: 465-694? <br /> VALUAT[~: <br /> <br /> 36 ; 9S ' 5E FY <br /> ' ' ........ : ............................ ~W"~ ........... : <br /> I <br /> <br />PEF;OMt'I' OR APPLiCATiON NO: :35157 <br /> <br />CONTRACTOR, NO. <br />NILI_A~E'fTE NATiCt~IAL FORF..~'¥' <br />DETROIT RANGER DIST. <br />HO 73 BOX 320 MILL CZTY 97360 <br />PHONE: 465-6g~? <br /> <br />TEST HOLES READY: <br />SITE EVALUATION NUiV~ER: <br />E;,-~ISTING TANK 51ZE: <br />EXIST/NS DRAIN FIELD <br />SEPTIC TN~K PUMPED: <br />PREV~O~J8 NO. <br /> <br /> ITE~ <br />SITE EVAb~ - FIRST ~000 G~L [I~F <br /> <br />QYJANTi I'Y AHOONT <br /> <br />TOTAL AS,S~ED FEES $180.00 <br />PREVIOUS RECEIPTS $180.00 <br />THiS RECEIPT $0.00 <br /> <br />8AL,ANCE DUE $0.00 <br /> <br />PAYEE: RECEIPT NO: <br />RECEIVED BY: Cl "'..'' · TYPE; CHECK ~: 0 <br /> <br />NOTE: THiS DOE~ NOT ~RANT OR IMPLY PER~I~'I~I TO. ~ILD ~ TH[S ~A~EL. ~NING ~D <br />~T~T~ PE~IT~ ~T 8E ~TAIN~ 8~0RE. 8UI~I~ OR.SEPTiC iNETAL~Ti~ <br /> <br /> THIS I~ NOT A PERMIT <br /> <br /> ~A~D E. ~OL~, ~R~, ~TY BU~LOtN80F¢IC~AL / B~ ............................ ~....~_ <br /> <br /> OFFICE COPY <br />FORM # MC 15-5~ REV, 4J9o <br /> <br /> <br />