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MARION COUNTY BUILDING INSPECT[ON <br />~ENATOR E, LDG. NO, 225 <br />220 HIGH ~TREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-S147 8:00 - 4.:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> have read,nd agree to the term~ stated on t~e ~eve~ si~ ~t DATE: ......................................... <br /> <br /> ~OOI_,SEY,¢ DONAL~ <br />.............................................................. m6~'¢~8~i54 ~W~ .................. ~-E~ ~9: ' "~ <br /> <br /> %].226 DE~ ~L, LEY RBCD SE ~ ................ * ...... t <br /> ~tJH~VI'L[_E OR 97~2o , H~D~ CSUNTY~ NO <br /> ........................................ ~ ......................... u ........................ f~. E~,,~[~& .': <br /> <br />~"~r~-~Eb~[~,. ................................................. ~ ~0 ~gT~T~ ..................................... <br /> <br /> BA~E <br /> PHONE: 749-2444 VALUATiON~ <br /> ; ~K~'K~ ................... ~%~E~6'~'. ' '. TOWNSW ~: ~ RANGE ZONE, <br /> <br /> ........ e ........ ........ ................ ...... <br /> ~D~ ' AR~A; ~ UNITS; <br /> <br /> ................... ==,--"t .................. ~L ..................................... = ~,~ <br /> <br />TYPE.' ON-SITE SEWAGE <br /> <br />PERM~CT OR APPLICATION <br /> <br />CO!'FFRACTOR~ NO. <br />)~OOi..SEY ~ DLll,IAL~ <br />SAH~ <br /> <br />PHONE: 74?'-2444 <br /> <br /> ITEM <br />ANNUAL EVAL. - TENP OR NQSHP NH, <br /> <br />WATER SUPPLY <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTIN~ TANK SIZE; 500 <br />EXISTIN~ DRAIN FIELD LIN~S: <br />SEPTt~ ~ANK PU~E'ED; 4/26/91 <br />PREVIOUS NO. <br /> <br />QUANTITY <br /> 1 <br /> <br />225 <br /> <br />$8.00 <br />$0.00 <br /> <br />9847466 <br /> <br /> ~OTAL .A. DSESSED FI'lES <br /> REVIOU$ RECEIPTS <br /> <br /> '~ B~ANC'E DUE ' <br /> PAYEE: WOOLSET~ .DONAk~ ;' · .. RECEIPT N~: 4'27~9 <br /> RECEIVED B(: HBj~.~ ........................... TYPE; [,K C. HEC~ ~. 77~ <br /> <br /> SEE ATTACHE~ DOCUMENT FO~( REQUIRE~EWT~ OF ON-SITE 8~WAg~. SYSTEM. <br /> <br /> · THIS IS NOT A ~R~IT.' THI~ APPLI~ATZQN .~T ~ THROUGH A REVIEW PROCE~ WHERE THE <br />SOLLO~IN~ HbST B~ CO~PL. ETE~,, ~j lo THE RE-, ONSI~ILZTY gF THE APPLIOAET TO AB~URE THAT <br />ALL NgCE~SARY iNfORmATION HAS ',BEEN PRO~[DE~ <br /> <br />PI.~N ~E//..EW ~Y__ D, ATE CiTY JURISg...C]ION. t~Y . gATE <br /> <br />;onu # ~c ~s.s~ ~, ~ OFFICE COPY <br /> <br /> <br />