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MARION COUNTY BUILDING INSPECTION <br />SENATOR IBLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM. OREGON 97301 <br /> <br /> PHONE: ~-5147 8:00 <br />24 HOUR CODE-A-PHONE: ~8-79Gv; <br /> <br />A'/L <br /> <br /> of a ¢eSistered buit~e¢, -- ............................... <br /> <br /> DA, T?. 0~/L9/93 TZflE: 14:06:09 <br />~ b~['~ .................... ~' ............................................. ~""'"' ~ ..................................................... ~: .................... <br /> <br /> 922~ 92~3 W STAYTON RD SE ~ , ..................... $ ........................... <br /> : ~C~l~l~v, U~ j ~gg~ANt <br /> <br /> Sg~E ........................................................................................................................... : <br /> PHONE: 749-1~8~ VALUAT]:ON: <br /> <br />?~.: ,o.~ j~"~: 2.81 [u"~m~C .......................................... I NO , SO ~ ............ <br /> <br />WATER SUPPLY: PW <br />TEST HOLES EEADY= <br />SITE EVALUATION NUHBEE~ <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES= <br />SEPTI~ TANK PUMPED: <br />P.RE~IOUS..ND, .BEDROQHS: <br /> <br />TYB~E: ON-SIT[ ~'EW~E <br /> <br />PERMIT OR APPLIC~T[OH I~: <br /> <br />CON'~RACTOR~ NO. <br />JENSEN, DAI. LA~ <br />SAME <br /> <br />PHONE: 749-10B9 <br /> <br /> I TEN · · . QUANTITY AMOUNT <br /> ANNUAL EVAI.. - TEMP OR HDS~P MH · .~: 1 $9~.80 <br /> <br /> · '-": ""',", ,"~" ,'r ~' :'~ '~,',:,';:,,'~E~.OU~.-:RECEIPT~ <br /> <br /> .. ........... , .... ~.~ ..... , ,.. ,.., .... ~,. <br /> · ":.'", .... ,, <br /> <br /> · TN~S IS ~T A ~RHIT.,-.THI'B~ ~PL.t~T~Q~ "~'~"'~ TH~U~ A REVIE~ PROCESS W~RE <br />FOLLOWING HLJST BI COHPLETEg; :' [T'I'S THE '"~SPONS[BIL~T.Y,OF~ I'HE APPLICANT TO ASSUR THAT <br />ALL NE~ESSAEY INFORMATION HA~:~EEN PRO~E~, ",,',' ','" ,. : E <br /> <br />OFFICE COPY <br /> <br /> <br />