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MARION COUNTY BUILDING INSPECTION
<br />SENATOR SLOG, NO. 225
<br />220 HIGH STREET NE
<br /> SALEM~ OREGON 97301
<br />
<br /> PHONE: 68~-6147 8:00 - 4:30
<br />24 HOUR CODE-A-PHONE: 588-7904
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<br />I am 0erfofming work on a property I owfl of O~upy. '
<br />[ am ~ ?egis eted builder OR the euthorized representer ve
<br />
<br />~IGNATURE OF APPLICANT: ................
<br /> DATE~ ......................................
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<br /> 562 N 11TH
<br /> AUMSVILLE
<br /> PNONE: 747-1503
<br />
<br />--'r~~ .......................... 'jo~m'w ' -'
<br />wi w: :
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<br />TYPE: 0N-SITE ~E~A~E
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<br />PERMIT OR APPLICATION NO~
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<br />C~NTRACTOR~ NO, ~4~1&
<br /> STAYTOH SEPTIC
<br />411~5 STAYTON SCIO DR SE
<br />STAYTON. 7738~
<br />PHONE: 7&9-2~02
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<br /> WATER SUPPLY: PW.
<br /> TEST HOLES READY.
<br /> SITE EVALUATION NU~BERt
<br /> EXISTING TANK SIZE.
<br /> EXISTING DRAIN FIE~D LINES:
<br />· k'SEP¥tC,TANK, PUMPED.
<br /> PREVIOUS NO. BEDROOMS:
<br />
<br /> ITE~ ...... .., . QUANTITY AMOUNT
<br /> STAN~AR~ 0N-SITE SYSTE'M '":'..-:., '..'.
<br /> .. .::.,,,, ~" .. ,,. 1 $255~0~
<br /> ' '. ' : T0~L,,ASSESSED ·FEES $255.00
<br /> ': ...... ,.., ,'PREV~0L~:RECEIPT6 $255.00
<br /> . .. '.,,',,",:".-EHIS'RECEIPT.. .. ' ' $0~00
<br /> · .' :,':,::i,.,',/:':..:':i.'::.:'...':",',"DA[AN~E..'DUE.,, $0.0~
<br /> ....... I^,, :'ii':,::::':: .::::'::'::',". '"::'::::':':':'"':":': '"":": ." ,ECEI,T NO, I
<br /> :* ~-- ~_:~4L~..1~.,¢'~; '," :'~ i2.:~'£;g':S~,".'~,"'.'-'.' ',, :", TYRE~ CHECK J: 0 ·
<br /> I
<br />ZONING ORQtflANCES~ TNIS 'PERNIT'~BHAL~BEOOHE. NULL.,AN~.VOig. ·
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<br />REHARKS:
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<br />DOI'IAL, Q E~ WO,ODLEY,
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<br />MA?~ION COUNTY BUILDING O'PFICIAL / BY
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<br />OFFICE COPY
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