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MAHIUN L;OUNIY EIUILDINf~ IN~PEr. jTiON <br />SENATOR BLOC. 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: 588-7~D4 <br /> <br />I ~ am perfo ming work on a property I own or occuOy, ' ~ <br /> <br />', 6W'NE~ ................................... ~"~ ~'0¥: CATEGORY; <br />' DATE: 09/i~/?~ TINE: <br />'S~TUS AO~E~" PHILLIP ~ KATHerINE . co~~;' ' ,,O~NTtAL <br /> <br /> ~' ~0~+~ '~l~: ........... ,-b~ ................................... <br />=~u~ ~ ~d~5~~E6 IT ............................. ~E' <br /> <br /> 5018 DANIEL ST S <br /> SALEM 97~B6,,, WK 588-8585 ~ SITE ~ER: ~-~24~6 <br /> ~,HQ~E~,,~,~9. ,~877 ....................................................... ~LDA~IO~ .........~ ~'0~: ............. r~: .... <br /> <br />................. '~'~ ........ : %~6 &C ........................ <br /> ................ ........... .... , [ ..................................................... ....... <br /> <br />TYPE: OH-SITE SEWAGE <br /> <br />PER~IT DR APFI. ICATION HO: 9844~481 · -[ <br />FISHER, PN~LLIP & KATHERINE <br />5018 ~ANIEL ST $ <br /> <br />WATER SUPPLY: CW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXIST[N~ TANK SIZE: <br />EXI~TIN~ DRAIN FIELD LINES: <br />SEPTIC TANK PUMPE~: <br />PREVIDIJS NO. BEDROONS~ <br /> <br /> ITEM <br />REPAIR - MAJOR <br />AUTHORIZATION NOTICE - NO 'VISIT. <br /> <br /> .'..TO~AL.A'SSESSE~ FEES <br /> -PREVIOUS. RECEIPTS <br />,,,,,'THIS..~ECE!PT '.. <br /> <br />QUANTITY AMOIINT <br />I $t25.00 <br />1 $95,00 <br /> <br />$220.00 <br />$168.00 <br /> $8.08 <br /> <br /> · '" AL uC <br /> · ,,', $60.00 <br /> PAYEE: "' ....:,' ":' '""~: .... ' ' ' <br /> ECE. D BY, <br /> <br />$ THIS 19 NOT A PERHIi. ··THIS· A~PLZ~TION HUS? ~ THROUGH A.REViEW PROCESS WHERE TNE <br />FOLLOWIN[ MUST BE CO~PLETE~, .,,iT,IS,'TNE..RESpoNsIBtLITy OF THE APPLICANT TO ASSURE THAT <br />ALL NECESSARY INFORMATION HAS BEEN PROVtDE~."" .. <br /> <br />PL.A~ ~EY~EW, ~Y ~.-~k.'D DATE _'~LEl.~i*.-_~_~__ C~TY JURISDICTION= ~Y DATE <br />REMARKS: AN/H JR REPAIR NEXT INSPEC. HDSF' RENEWAL 9-3-9~ <br /> <br />OFFICE COPY <br /> <br /> <br />