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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. ,NO, 22.5 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> ~ PH.ONE 588-5147 <br />CODE-A-PHONE 4:30 P.M. - 8:00 A.M, <br /> <br />of a registered builder. <br /> <br />Other,. <br /> <br />.,~A.E;" T'("'?/, d."'~'7/, T!l~lE: <br />dWN~R: <br /> <br />TAX LOT'. i oA~EGORY: <br /> 55351-8 ] S <br />~ONST~UCT ON TYPE; OCCUPANCY: <br /> <br /> 852i HOL~OUiST RD <br /> .,,&U~dSV _~ L L :L''' OR 9?325 <br /> <br />' USE OF BUILDING'. <br /> <br /> SE , CONTRACT CITY'. IJ~; <br /> <br />....... ~AR~,Qb! .CQUNTY N.} <br /> <br />MAILING ADDRESS: <br /> <br />SUBDIVISION: <br /> <br />.SAL E!vf OR !_.; 73 d 5 <br /> <br /> SITE NLi~IBER: ]909 <br /> VA,_~A ON · <br />LOT: BLOCK: SECTION: ! TOWn'HIP: ' RANGE'. ' ~0NE'. ; MAP: <br /> <br /> AREA: ~ UNITS; , IRREG. LOT: CORNER: <br /> 2.86000 : AC NO NO <br /> <br />~y <br />: PE; ON-SITE SEWAGE <br /> <br />,:>:_~alvf'.'T' :}R APPL;,rCATZON NC: 9003222 <br />CONTRACTO~, N, .,,. ~ <br />GODDA~D, SA~ & ~OSE <br />39~7 ISERZS 5'T h[~ <br />SALE,v: Ok 97305 ~/ <br /> <br />I,~ATER SUPPLY: PW <br />TEST HOLES READY: <br /> <br />F. XZS'rING TANK S~Z~: <br />~IS7ING DRAIN FIELD LIN~S: <br />SEPTIC TANK P'd~PED: <br />PREVIOUS NO, ~DROO~S: <br /> <br /> I TE% QUANT l Tv Ai¢iOL il,iT <br />PRESSURE DISTRIBUTION <br /> TOTAL' AS~SED FEES <br /> F'REVI OL;S RECEIPTS <br /> THiS RECEIPT <br /> <br />/'~,YE~:t ~,~O¢;,,A~,, S.:~,h~ & ROSE <br />5. ECE!'VT~-3Y,: ;>1~ <br /> <br />SEE .AT'fACHEO DOC. LJiv]ENT FOR <br /> <br />DUE <br /> <br />INVOICE NO; 3?59 <br />TYPE: CK CHc:.~,", ~; <br /> <br />SYSTE~I- <br /> <br />REVIEW PROCESS N-tERE THE <br />HE APPLICANT TO ASSURE THAT <br /> <br />* THIS IS NOT A PERi'lIT. THIS <br />FOLLONING FMST BE COf',IPLETED. <br />ALL NECESSARY INFORNATION <br /> <br />RE:~,~,,RKS ~ LQW PRESSURE <br /> <br /> <br />