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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 />have read and agree i0 the terms sta e,~ on he reverse s de of DATE: .... _ ............................. <br /> <br />DATE: 08/19/72 TIHE: <br />8ARLO~ THOHA$ ~ RESIDENTIAL <br /> <br /> ~934 ~]LL CREEK RD SE <br /> AUHSV~LLE OR 97525 ~HARION COUNTY~ NO <br /> <br />SANE <br /> <br />PHONE: <br /> <br />749-1782 <br /> <br />SITE NUHBER: <br />VALUATION: <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION, HO: <br /> <br />CONTRADTOR, NO. <br />BARLDW, THOHA$ <br />SAHE <br /> <br />41790 <br /> <br />WATER SUPPLY; PW <br />TEST HOLES READY: <br />SITE EYALUATION NUHSER: <br />EXISTING TANK SIZE: 12oo <br />EXISTIN8 DRAIN FIELD LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS. NO. 8EDR00NS: 2 <br /> <br /> I TEH QUANT I T Y AHOUN T <br /> AUTHORIZATION NOTICE - FLD. VISIT i $150.00 <br /> <br /> TOTAL ASSESSED FEES $13o.0o <br /> PREVIOUS RECEIPTS' $1~0. O0 <br /> THIS RECEIPT $0,00 <br /> · ' '., ,'~ALANCE' OUE $0.00 <br /> <br /> P~YEE: ·..-- ,,, ...,. , REOEIPT NO: 0 <br /> RECEIVED BY: PB .............. TYPE; CHECK F: 0 <br /> <br /> SEE ATTACHED DOCUMENT FOR EEQUtREHENTS OF ON-S~TE S~WAGE <br />· THIS is R VALID PERH)T · THZ~ PERHIT EXPIRES ~0 D~YS FROH ITS ISSUE DATE. IF <br />COHSTRUCT[OH F~[LS TO HEET ALL REQUIEEHEHTS OF <br />ZONIN~ ORDINANCES, THIS PE~H[T ~HALL BECOME NULL AND VOIO. <br /> <br />REHA~K$: <br /> <br />DONALD E. <br /> <br />AUTH - FIELD CHECK <br /> <br /> WOODLEY, MARION COUNTY BUILDINQ OFFICIAL / BY <br /> <br />OFFICE COPY <br /> <br /> <br />