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MARION COUNTY BUILDING INSPECTION <br />SF:NATOR 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: s88-7904 <br /> <br />I am per 0 tn fig work OM a OrOOertY I OWn or OC~, Upy, . <br /> <br />this document. <br /> <br />DATE: <br /> <br /> 3~ SW CARAWAY Cr ~ <br /> PORTL.OND~ OR 97219 ' SITE N~8~: 94-~119~ <br /> PHONE: 244-6221 ' VALUATIONt <br /> <br /> . ~ ......... ~ ....................................~ ............... <br /> <br />TYPE¢ OH-SITE SEWA'r.E <br />PERHIT OR APPLICATIOH HOc 9653763 <br /> <br />CONTRACTOR. NO. 1~§7~ <br />B%a~].ey M ~eightI~7 . " <br />13640 Oak Rd gW <br />Sa~e~, ?7304-0008. <br />PHONE5 B6B~738B ,, <br /> <br /> WATER SUPPLY~ CW <br /> TEST HOLES READY: <br /> SITE EVALUATION NUMBER: 3fl743 <br /> EXISTING TANK,SiZE: <br /> EXISTING DRAIN FIELD LINES: <br />· $[PT~"TANK PUMPED~ <br /> PREVIOUS NO. BEDROOMS: <br /> <br /> ITEH QUANTITY AMOUNT <br /> STANDARD ON-SITE SYSTEM .., '' · ' ' 1 <br /> <br /> ~ "',', ..... .TO~,A~ ,~'SSEMSE'~ F~ES $255. <br /> . '.,. PREVIOUS RECEIPTS <br /> ,.. ",,,, .:' ...,TH'~S" RECE~F~T' ' <br /> <br /> · ' ,',',,,,, '.. · '. <br /> PAYEE~ S~a'ley ~ Keigh~ley : ', ' -' ,'" ""'.".-" INVOZ~E NO: 58233 <br /> RECEIVE9 BY: PM .., · ..~. ,~.~'.,,~ .' .-.~,;.~ .... ""' .~.. TYPE: lfl CHECK ~: <br /> SEE ATTAOHE~ DOCUMENT FOR'EE9UIEEHENT$ OF-ON=Sl~ SEWAGE <br />· THIS,iS NOT A P~/T. THIS ~[~TZ~ ~ ~ T~H A REVZEW PROCE~ ~HERE THE <br />FOLL0~NG HUST ~ COHPLETE~,' ZT .ZS THE RESPONS~ZL~3'Y' OF'THE ~PPL~:ANT Tg ~SSU~E THAT <br />ALL NECESSARY ~NFORHAT!ON HAS' ~EEN PROVIDED. '', . ' <br /> <br />REHARKS: BS <br /> # <br /> <br /> <br />