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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: 588-514.7 8:00 - 4:30 <br />r , j~ ~OUR CODE'A-PHONE: 588-7904 ~'~ , <br /> <br />PiLE <br /> <br />..... DA,~E.: · 09/g8/93 ........ l: I FkE-: --- $ -1-:4 't: Z~ ...... F~'^X-£6t~ .............................. ~ C~TEGd~Y:' ' <br /> OWNER: <br /> <br />: BRUCE PACK,NO COiF'ANY (B~UCE PACK) : , COMMERCIAL <br /> <br /> 12264 SILVER FALLS HWY __ , CONTRACT OI~Y: ~ UG: . <br /> <br /> 973~.~ MARION COUNTY:. NO <br /> AUMSVILLE OR ~ <br /> <br /> F'NBNE: 7~9~2139 VALUATION: <br />'LOT'. <br /> <br />70 <br /> <br />' NO NO <br /> <br />TYPE= OM~SITE <br /> <br />PEE~T OB APPLICATI~ <br /> <br />CONTRACTOR, NO. ~6949 <br /> AAA S~PTIC 9B~VICE <br />PO BOX 28811 <br />SALEM, 97~07 <br />PHONE: ~78-7454 <br /> <br />WATER ~UPPLY <br />TEST HOLES READY: NO <br />S~TE EVALUATION NUMBER: <br />EXISTIN~ TANK ~IZE: <br />EXISTING DRA~N FI£L.B L~NE~: <br />SEPTIC TANK PUNPE~: <br />PREVIOUS NO. BEDROOMS: <br /> <br /> ITEM QUANTITY AMOUNT <br /> STD ONSITE SYS < 180~ GAL 1 $255.00 <br /> C & R -- EACH ADDL. 580 GAL DSF 1 <br /> <br /> TOTAL ASSE~ED FEES ~270,00 <br /> F'REV~OU$ RECEIPTS <br /> THIS RECEIPT $270.00 <br /> <br /> BALANCE DOE <br /> <br /> PAYEE: BRUCE PACKING CO.~ INC RECEIPT NO: 52877 <br /> RECEIVED BY~ CL .................................. TYPE: CK CHECK ~: 2700 <br /> <br /> SEE ATTACHED DOCUMENT FOR. REQUIREMENT~ OF ON-SITE'SEWAGE SYSTEM. <br /> <br /> * THIS IS HOT A PER~IT. THIS i~PLICATIOtl MUST.CO TI'IEOUCH A REVIEW PROCESS ~flERE THE <br />FOLLOBIN~ MUST BE COHPLETED, IT IS THE RESPON~ZB[LITY DF THE APPLICANT TO ASSURE THaT <br />ALL NECESSARY INFORMATION HAS BEE~ PROVIDED. · <br /> <br />REMARKS: SS:M JR TH:NO <br /> <br />CITY JURISDICTION: BY ......... DATE ............. <br /> <br /> <br />