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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; 568-5147 8:00- 4;30 <br /> <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />.ow.~:..DATE.-, t ~114t.9 3 <br /> CNECKAL ~ JOHN <br /> <br />..................................... : ~b-N~T~U~'Tib N' TYI~:' ......... bddUP^NC~: "' <br /> <br />OATE; ........ <br /> <br />1321~ ~EOOKSIDE DR <br /> <br />; ~UROR~ OR 77~2 ~ HA~ON COUNTY~ NO <br /> <br /> . GRiN ~ST~TE~,.. <br /> PHONE-" 678-5414 V~LURTION: <br /> <br /> ', ~ 1.2' AC YES ~ NO <br /> <br />~ATER SUPPLY= Pa <br />TEST HOLES READYa NO <br />SITE EVALUATION NUMBER: <br />EXISTIN~ TANK SIZE: 1~0 <br />EXISTIN~ DRAIN F~ELD LINES: <br />SEPT~CTANK PUMPED: 11-16-87 <br />PREV~OU~ NO, BEDROOMS: <br /> <br />TYPE.- ON-SITE SE-~AGE <br /> <br />PF-.~HiT OR ~PPLZCATION <br />CONTRACTOR. NO, <br />CHECKAL, JOHN <br />SAME <br /> <br />PHONE: 678-5414 <br /> <br /> ITEH ~UANTITY AHOUHT <br /> PAZR - MINOR ,,, 1 <br /> <br /> ,. ,,, PREVIOUS ;'RECEIPT~ ~e. 8~ <br /> THZ,~ R'E~IPT.'" $85,8a <br /> BALANCE DUE $8.88 <br /> PAYEE: CHECKAL. JOHN · · . ' ' "','.,,, , ,.'' R~CEIPT NO: 53~74 <br /> RECEI~9 BY~ H~ .............. '.~ ...... L ..... ~ ...... TYPE~ CK CHECK f: 2?7 <br /> SEE ATTACHE9 90CUHEWT FOR EEQU[EEHEN~:8 'OF,,ON-B~, BEWA~E SYSTE~. <br /> · THIS ~$ NOT A P~NIT.' ~HIS .~Z~TIO~ N~T,~,,TH~H A E~ZEH PRO~ ~E~ T~ <br />FOLLOWING MUST BE COMPLETED. IT IS ~NE ' RESPONSIBILITY OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORMATION HA~ ~EEN PRQVIDE~.' <br /> <br />PLAN ~EVIEW: <br /> <br />REMARK~ RPR~ MIN <br /> <br />CITY JURISDICTION: BY .......... DATE .......... <br /> <br />OFFICECOPY <br /> <br /> <br />