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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: 51B8-5147 $:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />"'~^X LOT: CATEGORY; <br />o~ ~,f~$~$: ........ o ~i;,,~,RF~ I .[ AL <br /> <br /> 87:~4 SHAW ~LIUARE RD SE <br />~umo,~MSVILLE OR ?72;2~ <br /> <br /> .............. ,b¢¢UP~'WT LOAD: <br /> <br />HARION COUNTY: NO- .............. <br /> <br /> Sill[ HUMBER: 9~-e~77t <br />VALUATION: <br />.........................nA~: ~d~E: ........ <br /> <br />MAP: <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CPNTRA~TOR. NO, ~949 <br /> AAA S~F'TIC ~ERV;ICE <br />PO BOX 20811 <br />SALE~ ~7307 <br />PHONE= ~7g-7454 <br /> <br />9es~267 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY~ YES <br />S~TE ~¥ALUATION NUMBE~ <br />EXIST~.NG TANK BIZE: <br />EX~STIN~ DRAIN FIELD LINES: <br />'SEPTIC TANK PUMPED: <br />PREVIOUS NO. BEDROOMS: <br /> <br />l T'EM QUANT I TY A~OUN'F <br />REPAIR - MAJOR 1 $1~5.08 <br /> <br /> TOTAL ASSESSED. FEES <br /> <br /> THI~ RECEIPT <br /> <br /> ~ ~- '" .'.. BALANO~ DUE . <br /> <br /> SEE AT'TACHE~ DOCUMENT FOR REQUIREMENTS'OF ON-SZT£ SEWAGE SYSTEM. <br /> <br />FOLt..QWIH~ HUST BE ~OHPLETED. IT [~ THE.. ~EBPONB[B~LITY .OF THE APPLIOAHT TO ASSURE THAT <br />ALL NECESSAEY INFORMATION HAS BEEN,:P~OVI~ED. <br /> <br />PLAN REVIEW: BY ........... ~ATE <br /> <br />REMARKS: RPR:HJR TH:9-29~93 <br /> <br />CITY JURI~'DICTION: BY ............. DATE ........... <br /> <br />OFFICECOPY <br /> <br /> <br />