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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: 588-7904 <br /> <br />SIGNATURE OF APPLICANT; . . , <br />~ONSTRU{;TION TYP~: <br /> <br /> 6273 ~HAH LANE <br />AUMSVILLE OR 9?325 <br /> <br />....... ' <br /> <br />, ; <br />~'~'~'~T"cJT~: ' ":'O(~: ........ .b~UPAN¥ LOAD: <br /> <br /> ~5iTE NUMBER.* 92-00660 <br />PHON~: 7~9-2S$3 : VA~A'r [~: <br /> <br /> 24 8~ 2W : AR3 <br /> <br />51 <br /> <br />PHON~: 749-2553 <br /> <br />HAI'ER ~UPPLY = <br />TE!~T HOLE2~ READY*. <br />~ll'E EVALL~TION NU~ERt <br />~iSTIN~ T~K ~iZE: 1000 <br />~[~TZN~ O~IN FIELD LiN~: <br />SEPTIC T~K ~E~: 1-28-91 <br /> <br /> I~-EM <br />ANNUAL E%tAL. - TEMP OR HI~P MH <br /> <br /> $75.00 <br /> <br />TOTAL ASSEE~ED FEE~ $75.00 <br />PREVIOJ$ RECEIPTS $75.00 <br />THI~ RECEIPT $0.00 <br /> <br />BALanCE CUE $0.00 <br /> <br /> PAYEE: RECEIPT NO'. <br /> RECEIVED BY: cl TYPE: CHECK ~;** 0 <br /> <br /> SEE AT'rACHEO O(XTJ~T ~R R~I~TS OF ~-SZTE ~E ~T~. <br />~ ~IS I~ A V~ZD P~iT · .THIS PE~iT ~l~ 360 ~ F~ 1~ I~E ~TE. IF <br />~T~CT[~ FAZ~ TO ~ET ALL ~~ ~ STATE ~ ~D ~RI~ ~TY ~ ~0 <br /> <br />REMARKS: HOOP RE~EV;AL ~ LO~N REPORT <br /> <br />DCNALD E. WK~ODLEY, NARiON COUNTY 8UILOING OFFICIAL <br /> <br />OFFICE COPY <br /> <br /> <br />