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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 /> 2'4 HOUR CODE-A-PHONE: 588-7g04 <br /> <br /> ,[ am perfocm,ng work on a propertYam a Cegiste,e, ( , own or occupy. ' NATURE APPL CANT <br /> build~ OR the authorized representative S ~ OF ;..~ ~T~2.~ - <br /> <br />HOLT~ ~0~ ~ 757282¢8 , ~, , ~ RESIDENTiaL <br /> ~IlHSVILLE OR 97325 ~ M~RION COUNTY'; <br /> <br /> SAME <br /> SITE HUHB~: 73-8~172 <br /> PHONE: VALUATION: <br /> <br />TYPE: OH-SITE <br /> <br />PERMIT OR APPL[CATIOH <br /> <br />~49913 <br /> <br />WATER· SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVnLUATION NUHBEE: <br /> <br />CONTRACTOE~ NO. <br />STAYTON SEPTIC <br />411~5 STAYTON 8OI0 OR.SE" "' <br />STAY'ro . <br />PHONE~ 7~9-2~02 ' · <br /> <br />EXISTIN~ TANK ~ZE: <br />EXZSTIN~ DRAIN FIELQ LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO.'BEdROOMS: <br /> <br /> ITEM ., · , , ' ~UANT~TY AMOUNT <br /> REPAI'R - MAJOR "'"; '."": '" "" ! $125,00 <br /> · '/".: ":.; :.:.") , :'.:,,. :'",,,'.-T~TAL ,,AS~ESS£]~ FEES <br /> $125. <br /> :. ..-:..'l.,...':...'",','. ',~HI~ R~CEIPT".':" <br /> <br /> · ...:.; :..... "-.". .... "',~ ',8~LANCE,.,~UE'.' <br /> PAYEE: STAYTON SEPTIC..'I' aI''':~' "" ' ' ':':'':''''~'':''''' RECEIPT <br /> RECEIVED BY: CL , ",,',";:~ "."'.~::.'"'.:::.~?~'::"..::..'?:":'~7~:"' .., ~, .. ......... , TYPE.' CE CHECk' ~ 14288 <br /> ......................... <br /> ~ THIS IS NOT A PERH~:T. , ~..:~PPLICATI'ON. ~T ~ T~OUGH ~ REVI/H PROCESS ~RE THE <br />FOLLO~IH~ ~OST ~E COHPLETE~. ,~T ,IS THE .RE~PO~S[~[L'I'~Y OF ,THE ~PPLIC~flT TO ~SSUEE T~T <br /> <br /> PLAN REV:JEW: BY ......... L '~ATE~_;'L:~:,"='~'j'L":22' 'CITY JURISDICTION: BY ........ ~ATE <br /> REHARKB: TH: ~-15-9~ <br /> <br />OFFICE COPY <br /> <br /> <br />