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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: ,~8-7904 <br /> <br />~IGNATURE OF APPLICANT ............ <br /> <br /> DATE: .0~/~,~/93,o ':~*~ ·.TINE'-' 1:~.47.,,4,4" , ................................ <br /> <br /> 8ENI'ON. DENNIS & LOLA 9022~37~ <br />"sn0s' ........... ~b~ss~' : db'~bbT~6~ ~v~ <br /> <br /> 455 NM ~ANTIA~ AVE <br />DETROIT <br /> <br />'LOT: <br /> <br />WIDTN~ <br /> <br />; DFTR~IT : NO <br /> <br /> · , ....... HO~t0L~D ............ <br />PO BOX 866 <br />HINES OR 9?738 ,. SITE RUH~EAr. - <br /> <br />14~ ' 1~I. 187~. ~ SF NO ~ YES <br /> <br />TYPE: OH-SITE <br /> <br />P£RI~IT OR APPLICATION NO: 91~4~537 <br /> <br />CONI'~ACTOR ~ <br />B~HTOI% DENNTS ~ LOLA <br />PO BOX Et66 <br />N[NE~ QR ~77~8 <br />P14DN~: 573-323? ,, <br /> <br />WATER SUPPLY: <br />TEST HOLED READY: <br />SITE EVAL, UATIOW NUNBER~ <br />EXISTING TANK <br />EXTSTTH(; DRA~N FIELD <br />SEPTI~C TANK <br />PREVIOUS NO. BEDR(,;OI4S~ <br /> <br /> ITEH QLIANT.C rY Ai~OUNT <br />AUTNORIZATION NOTICg - FL.D,, VISIT -,$J. 6~,.0~ <br /> <br /> TOTAL ASSE.,~E.D FEES -$16~,~ <br /> PREVIOUS RECEIPTS $~. ~6 <br /> TH~S RECEIPT -$~6~). ~ <br /> <br /> BALANCE DIJE $(~. 88 <br /> <br />PAYEE: DEIqTON. DENNIS & LQLA 4775~ <br />RECEIVED BY: CL ....................................... 't'YPE:~ I'N CHECK $: ~ <br />SEE ATTACHE~ ~OCUHEN~ FOE REQUIRENENTS OF QN.,.,8~TE SEWA[,E ~YSTE~. <br />TH~S IS NOT A PERHIT. THIS IS A EAH~ELLATIDN ~U~ENT, <br /> <br />REHARKS.~-:CAMCEIZL'A'.T]i.'ON" OF"~UN~5'~UED "A'P~,IzICAT{'QN fPG':45:~SI., ': <br /> <br />Fon~ ~ ~ ~-.~ n~v. ~ OFFICE COPY <br /> <br /> <br />