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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 />DATE: .................. <br /> <br />MAiLiNG ADDI-IE~.~,[: ~ SUBDIVISION: [~C[ <br /> PHONE: 749-2553 SITE NU~ER: 92-00580 <br /> VA~AT i~: <br /> <br />LOT; <br />W~DT~': .............. ~fi~ET'~; .................. ;X~A~ .... 1-41 ''b~mm ' ' AC"."m~&'LET:"-'NO ':86~'~NO <br /> <br />OONTRACTOR, NO. <br />rYE:COy, RONALD <br /> <br />PHONE: 749-2553 <br /> <br /> ITEM <br />ANNUAL EVAL. - 7'E~P OR HOE, HP ~ <br /> <br />9038213 <br /> <br />TE~T HOLES <br />SITE ~WA~AT$0N NU~ER: <br /> <br />~ISTING D~N FIELD LiN~: <br />~EPTiC 'I'~K ~MP~D: 1-28-91 <br />PR~I ~S NO. <br /> <br />51 <br /> <br />PAYEE: NCCOY, ~ONALD ~'"~ <br />RECE,tVED E~Y: c] <br /> <br /> QUA~ T i I'Y A~N r <br /> $?5. O0 <br />TOTAL A$~E..SSED FEE;3 $75_00 <br />PR~i~$ R~EI PT'S $0,00 <br />THiS RECEIPT $75.00 <br />BA~CE ~E $0.oo <br /> <br /> .................................... .; ......... · ' TYPE: CA CHECK ~: 0 <br /> AT'FACH~D 00OJM~T FOR RFWlREME~ITE~ <br /> SEE <br /> <br />~ THIS iS NOT A P~IT. THIS A~T]~ ~T ~ ~ A R~I~ P~ ~RE TH~ <br />~LL~ING ~T BE ~PL~ED. [T IS TH~ R~IBILITY OF THE APPLIC~T TO ~ THAT <br />ALL N~ INFO~TZ~ H~ BE~ <br /> <br />~L/NN REVIEW: ~Y ..................... DA'F~ ............................... <br /> <br />RP_t~ARY,.S: H0.~P RP.~EWAL & LOAN REPORT <br /> <br />CITY JURISDICTION: BY OA'F~ <br /> <br />DFFICECOPY <br /> <br /> <br />