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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 58845147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />~ am performing work on a;2roperty I own or occupy. <br />lama registered builderOR( )~heauthorized re;2resentative <br />Of a registered builder, <br />The work will bo porformed by a registered builder. <br />Other. <br /> <br />have read and agree to the terms stated on the reverse side of <br /> <br />' OWNER: L/~4BREOl-IT ~, DEL,~I~ER TAX gdT: <br /> <br /> 5336 ANDERf~.,'~ RB SE <br /> <br />USE 0¢ BUILDfN~ <br /> 2 <br /> <br />[CATEGORY; RE.,..~ I DEN ')' I AL <br />I ocCuPANCY: <br /> <br />PHONE** 769-22~ <br /> <br />SITE NUfClBER: 4-80 <br />VALUATIOD4: <br /> <br />LOT: <br /> <br />WIDTH: <br /> <br />'BLOCK SECTION ~1~ TOWNSHII~;, ~S ~ANOE 31~ ZONE <br /> <br /> DEPTH: ARE,~ 25+ ' JNITS. A~ IRREG, LOT' NO , CO~NE~O <br /> <br />PERi, IT OR APPLiCATiON NO.* <br /> <br />CON'FP, AC'f'OR, NO, :, <br />L.NW~REOHT, DEL~ER <br /> <br />PHONE: 769-2204 <br /> <br />30238 <br /> <br />TEST HOLIE~ <br />SITE EVA~AI'I~ NU~ER: <br /> <br />~ISYIN~ <br />SEPTIC F~K <br />PREV[~S NO. BED~: <br /> <br />BALANCE DUE $0.00 <br /> <br />PAYEE: RECEIPT NO: <br />RECEIVED BY: CL TYPE: CHEEK <br /> <br />SEE AI'TACHEB [XTCUrflE~T FOR ~I.R~TS OF ~] TE 8~ SYS'F~. <br /> <br />REiN1AR~: HDSP AUTH 2 BDRIt4S ~ :UNIT I;~'r4955 ~(~ <br />O¢..~ALO E. ~OODLEY, MARION COUNTY BUILDING OFFICIAL / BY .................... ~_ : ....................................... <br /> <br />FORM # MO 1~-~6 REV, 4/90 OFFICE COPY <br /> <br /> <br />