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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. NO, 225 <br /> 220 HIGH STREET NE <br /> SALE.M, 9R~GON 97301 <br /> <br /> · PHONE 588-5147 <br /> CODE-A-PHONE 4:30 P.M. - 8;00 A.M. <br /> <br /> arn performing work on a property I own or occupy. <br /> am a recgistered builder OR the authorized represen ave SIGNATURE OF APPLIDANTI <br /> o a reg ~tered builder. ' <br />The work will be performed by a registered buiJder, <br />Other <br />; Save read and agree to the terms stated on the reverse side of BATE: " <br />this document, <br /> <br />OWNER: 'iAX LOT; CATEGORY: <br />SITUS ADDRESS: C0N~Rd~I~N TYPE: OCCUPANCY; <br /> <br />7477 ,.~H,..F~, ,..,h, ,,.., ~,~E : CONTRACT CITY'. , UGB; :O~UPANT LOAD: <br /> <br /> · ~ ~- ..... V NO <br /> ¢b&F',:~, Q., C,C U N , <br /> <br />MAIUNG ADDRESS: <br /> <br /> S,,V¢ <br /> <br /> :'Ii" O"'i E: <br /> <br />LOT: RLOCK; <br /> <br />SECTION: <br /> <br />AREA: <br /> <br />MAP: <br /> <br />' ~ATER SUPPLY; <br /> '?ESi' HOtElS READY: <br /> SiTE ~VALUATiON NUMBER: <br /> EX:STiNG TANK SiZE <br /> EXiSTiNG ;3~A:N PiE:...D <br /> S~P']':(:; -FAN~<, PU~PED: hi!L_.:_ <br /> PR~E'V:.OLi5 NO_ 3EDROOIvtS: <br /> <br /> tTE~ <br />AUTHORIZATIOk NOTICE .... ?LD, VIS!= <br /> <br />BALANCE. ,D .... <br /> <br />'~:~ ~,TT~CHE.~) OQ(;U"4EN': FOR REQU]:~ENTS OF O~::,T~ tSE~AGE SYSTEM ¢W:~ ............................................................. <br /> <br />ALL ~ECE~%A~Y <br /> <br />,~, m:v 6/~.' OFFICE COPY <br /> <br /> <br />