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MARION COUNTY BUILDING INSPECTION <br /> <br /> 3150 Lancaster Dr. N.E. · Suits C · Salem, Oregon 97305-1398 <br />Office Hours: 8:00-4:30 * Phone: (503) 588-5147 * 24-HR Inspection Line: (503) 373-4427 <br /> <br /> ~EPTIC PERMIT <br />DATE/TIHF : ~?/25/97 1~=43 PERHIT HO : 97-07§28 <br />TYPE = SP STATUS = ISSUED <br />O~CUPAHCY = R-~ ISSUED t ~9/25/~997 <br /> TO EXPIRE = B9/25/~998 <br /> PAGE 1 <br /> <br />WORK DFSC : ~NST CAPPIH~ FI[[ RFflFWAL 96-0789? <br /> <br />SITE AODRE~S : CITY: MARION COUNTY 8784 BROADACRFS RD NE AR <br /> <br />.SIJBlr)l V'[ S 1 ON : LOT: BLOCK: <br /> <br />CR('kc;s STRFFT : CASE RD <br />PARCF, L NUMBER'. 4'[85~-808 PROPERTY I.OCATOR: 042W25 03800 <br /> F'ARCFL S]~7F : t~.8AC ZONE: EFU <br /> <br />OWNER : Mil .LEE, ROBERT H <br /> <br />AIlTH AGFNT [ M)[,LE~.ROBFRT H <br /> A~DRESS . 7445 .ROSBY RD NE <br /> WOODBURN <br /> OR <br /> PHONE ~ 98J-4J58 <br /> <br />DEQ INSTAI..I.ER ~ <br /> <br />97871 <br /> <br />QKQ I.ICENSE~ <br /> <br />PHONE : <br /> <br />INITIAL. ~YSTEM: CAPPING FILL <br />RFP[~CFMFNT SYSTEM: SAND F~LTER <br /> <br />Units Oescr:lptton Fee <br />' '~ Permit Renewal, no'F~'e]d V~,szt 85.00 <br />I DEQ Surcharge 30.00 <br /> <br /> qssessed fees : 115.80 <br /> ~Adjustme~ts : <br /> Tote] fees : 115.00 <br /> Total payments: 115.08 <br /> PAYFE: MIL[FR, RO~ERT H Balance due : <br /> <br />THIS PERHIT I8 HI~N-TRA#SFERABLE N'ID EXPIRES ~&5 DAYB FROM ISSUE DATE IF WORK HAS NOT <br />COHHENCED 8R IF ~IORK FAILS TO HEET ALL REOUIREHE#TS OF STATE LAWS AND MARIOH COUHTY <br />ORDINANCES. <br /> <br /> APPLICANT: ..................... .~_ ...................... <br /> OF <br /> <br /> OONALO E WOO~I.EY, MARION COUNTY BUILBING OFFICIAl. / BY PBELL <br /> <br /> <br />