|
MARION COUNTY BUILDING INSPECTION
<br /> SENATOR BLDG. NO. 225
<br /> 220 HIGH STR~:ET NE
<br /> SALEM, OREGON 97301
<br />
<br /> PHONE: 588-5147 8:00 - 4:30
<br />
<br />t am performing wo~ On ~ Drope~ I own or
<br />
<br />I fleve read and agree to the terms stated'"~"~"'{h'~',euerse ~,d~ ~'
<br />
<br />AURORA OR 77002 &MARION COUNYY~ NO
<br />
<br />~ODZE~ KENNETH & JUDITH [ 402S7-0~e RESIDENTIAL
<br />
<br /> VALUATION=
<br />
<br /> J
<br />
<br />TYPE= OM-SITE SEWAF=E
<br />
<br />PERMIT OR APPLIC~¥IDN ~: 9B48696
<br />
<br />CONTRACTOR~ NO.
<br />~OOZE~ KENNETH & JUDITH ....
<br />
<br />PHONE:
<br />
<br /> WATER SUPPLY= PW.
<br /> TEST HOLES READY.
<br /> SITE EVALUATION NUH~ER=
<br /> EXISTING TANK SIZE~
<br />EX~STING DRAIN FIELD LINES:
<br />_SEP.T[C TANE, P,Q~PED: FORH G[V
<br />'PREV~DLF3"NO."'"BEDROOHS,-
<br />
<br />ITEH QUANTITY AMOUNT
<br />AUTHORIZATION NOTICE ? F~:D~.V'i$,I,,T,,' .' ..'....'"....:.....' ,,,",,,,:,':., :
<br />...., :,',',,.,~..'.'.:,.: c;~'::.:. .',,.:~ ,,, ,....., .-, : 1 $160.00
<br /> ~..-..'. ~,, ,' ,, ,,,, ,' ...... ~< ~,~,SESSE3). FEES $160.00
<br /> ;'.,i.-?,,,~:~,',,~,..'....,.:"..-.:~::
<br /> ........ ,,,,., ........ ~,..,.:..-.-...,',.':~,~,,~CE~T;..:. · s~.
<br /> ,, .,,.,,,,,,.,,...,:.:.:,......~.~,,,,:,,. :,,,~. . ...... $160.00
<br /> , ,.~:.'?"::::....':":':'?-"...'...,.,..:~AL'AN~E: DUE..:'..~, $0.00
<br />PAYEE= WAND-NELSON ,., , ........... '~,,,.<,c:.:.::.':':~..,.:~:.....:.....,:,~.~,,:,,,,',
<br /> ~ .,,,-?!: :..., ,-.:...',,,,~::~,:.~,, , .
<br />RECEIVED BY: cl, ,: .,...:,:,:,,.',-....~ ....... ',,..:'.,'.~.::~.:...<: ............... ,".. RECEipT NO: 5iOl&
<br />................ :::::::~__-==:~;~-.~;..~g,~g~';::'..".,.:? . TYPE= CK CHE~ ~. 44~
<br />SEE ATTACHE~ DOCUMENT.'",FQ,~,k~REQUIREf~ENT~:~;OF'ON~S}lT~".'SE~'GE'SYSTEM.
<br /> ..............................
<br />
<br /> '~ .'~. '. '..'. ',,','T:: .,' .. · :.',.~,,:,~':"',, ;': .; ".'
<br />PLAN REVIEW: ~Y.._ ::,DATE, :,~B~2;.'~,': ":>.C[TY. dURtSD[CTION: BY DATE
<br />REH~RKS: ,,"
<br />
<br />~o.u # uc ~-~ ~v.~ OFFICE COPY
<br />
<br />
<br />
|