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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. NO- <br /> 2~O HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588~5t47 8:00 - <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> O~ perfott~it~ work OM ~ properly I own od occuDy, <br />~ 3m a registered bu der OR ) he aUti~Orized reDrese~t;[t~ve <br /> <br />SIGNAYUR~ OF APPLICANT: ..................... <br /> <br /> DATE; ~, ..,.., ....................... <br /> <br /> ~Um~V,LUr.'' OR 97325 '~HARIOM t <br /> <br /> : <br />~ 1145& MgCL~LL, flN 'LN ~g : <br /> AUSVI~_LK~ ORE~ON. 97~2~ S~TE NU~: <br />~:, PHONE. 7~9-24~4. ~ VALUATION= <br /> <br />TYPE: OH~ITE SEUAGE aATER SUPPLY~ P~ <br /> TEST HOLES EEA~Y~ NO <br />PERMIT OR APPLICATION HO= ~-~5~h~ SITE EVALUATION NUMBER: <br /> EXISTIM~ TANK ~IZE: <br />CONTRACTOR, NO. 36786 EXISTING ~RAIN FIEL~ LINES: <br />VALLEY SEPTIC ' , . SEPTIC YANK PUMPED: <br />P 0 ~OX 524~ ' PREVIOUS NO. BEDROOMS: <br />SALEH~ g7~84 <br />PHONE~ 588-1115 (~,. . <br /> <br />REPAIR - MAJOR ,, 1 $125.0~ <br /> <br /> ' RECEIPT ND: <br />PAYEE: I ., TYPE: CHECK <br /> <br /> 'TOTAL A$~ESSED FEE~ <br />: PREV~'OUS RECEIPTS <br /> '-.THIS=RECEIPT.. <br /> <br /> ~ALAHgE PUE'. <br /> <br />$125.00 <br /> <br />$125.0~ <br /> $~.0~ <br /> <br />$0.00 <br /> <br /> RECEIVED BY: PB ........... =__=_=_= ................ ~ 0 <br /> SEE ATTACHE~ DOCUMENT FOR R~QU~RE~E'~'OF,~H-$I~E CEWg~E SYSTE~. <br /> · THIS IS A VALID P~RMIT · THiS'PERHZT EXPIRES' ~68'DAYS FRDH ITS ISSUE ~ATE. IF <br /> ,~ c D~ G <br />CONo~RUCTIO~ FAILS TO:MEET ALL REQUIREMENTS OF. STATE.LAW~ AND MARION COUNTY BUIL -N AND <br />ZOFI~IG 0R~I,4ANCES, TH~S pERMITi~HALL- BECOH~ NULF AN~ VOID. <br /> <br />DONALD. ~. WOO~L~T, HAR.[ON CO(,J~TY ~U):L~ING OFFICIAL / 8Y .......... ~ ........................... <br /> OFFICE CO~ <br /> <br /> <br />