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MARION COUNTY BUILDING INSPECTION <br /> <br /> 3150 LancMter Dr. N.E. · Suite C · Salem, Oregon 9730~-13~8 <br />Office Hours: 8:00-4:~0 · Pitone: (503) 588-5147 * 24-HR In~pe~tion UP, e: (503) 373~1427 <br /> <br /> AUTHORIZATIOH/ALTERATZOH PERflIT <br />~ATE/TII~E : ~8/~1/97 1&:31 PERHIT HO : 77-857~3 <br />TYPE : SP STATUS : ISSUED <br />OCCUPN~Y = R-3 ISSI~D : ~8/~1/1997 <br /> TO EXPIRE : 88/81/1W78 <br /> PAGE 1 <br /> <br />WORK DESC : ALTERATION:DRAIN FIELD ONLY: <br /> <br />S1TE ADDRESS : CITY: MARION COUHTY 10163 MILL CREEK RD SE AM <br /> <br />SUBDIVISION : LOT: BLOCK: <br />CROSS STREET : <br /> <br />PARCEL NUMBER : 75488-028 PR0PERTY LOCATO~. 881W31AB08408 <br /> PARCEL. SIZE : .6AC ZONE: AR <br /> <br />OWNER NAME : WOIE~,I~ORMA D <br /> <br />AUTH AGENT : SCHMALTZ KEN <br /> ADDRESS : PO BOX 5241 <br /> <br /> SALEM, OR 97384 <br />PHONE : 588-1115 <br /> <br />QEQ INSTALLER : VALLEY SEPTIC SERVICE <br /> <br /> PHONE : (50~) 588-1115 <br /> <br />LICENSE: ~678~ <br /> <br />Units Descristio~ Fee <br />--]7"- ~ltera~ion <br /> <br /> Assessed fees : ~78,08 <br /> AdjustMents : .88 <br /> Total fees : 378.88 <br /> PAYEE: SCHMALTZ KEN Totml pmXMents: ~78.88 <br /> Balance ~ue : <br /> <br />THIS PERHIT IS HOH-TRA#SFER~BLE ~ EXPIRES 3~5 BAYS FRON I~SUE I)~TE IF MORK H~S NOT <br />CONHEHCE~ 'OR IF IIORK FAILS TO HE'ET ~LL RESUIR~I~ATS OF STATE L~ ~ ~IOH C~HTY <br />ORBI~ES. <br /> <br />SIGNATURE OFAPPLICANT: ............................................ <br /> <br /> <br />