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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; 588-514,7 8;00 - 4;30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />Other <br /> <br />this document, <br /> <br />SIGNATURE OF APPLICANT; <br /> <br />...... H ~P, ZNELL~. _.JENE T.'TE ] AgSSDENT~AL <br /> <br /> 236 F'ATI:~CiA DR <br />m GL, ANDSTONE OF< 97~27 ~ SITE NUMBER: ~3-82148 <br /> F'I,,IO NE: 656.-29~F~ ~ VALUATION: <br /> <br /> ; : : OWNSHIP; ] ~ANGE'. ~NE; 1 MAP'. I <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br /> ~6A~...L <br />COh!TF~A~?'OR. NO,, - "~" <br />KEV:I:I',I' S BAOI4HOE <br />F'O BOX 465 <br />DETRO];T. 97342 <br />PHONE: 854-S797 <br /> <br />9047908 <br /> <br /> WATr'[R SUPF'LY: CW <br /> TEST HOLES READY: <br /> S]:'rE EVALUATI'ON NUMBER: <br /> EXISTING TANK SIZE: <br /> EXISTING DRAIN FIFLD LINi-"S: <br />: :I SEP,Tt:~;,TANN ,~iUHF'ED: <br /> PREVIOUS NO. BEDROOMS: <br /> <br />STANDARD ON-~IIE. SYsTEHi::ii:' : <br /> i :: :; EES <br /> <br />Q[JANTII'Y <br /> 1 <br /> <br />AMOUHT <br /> $255.00 <br /> <br /> ~255,,00 <br /> $0.00 <br /> $255.00 <br /> <br /> RECE]VE:O BY: M[~ ; 'tY~,F. 'r~ r r.r~' ~.. c~ <br /> <br /> ~T~:S I~ ~,.O.,T A A REVIEW PROCESS WHERE THE <br />,:??,,F.W,[N6 d{~o? ~E COHF;'LETEJ)~'., I: RESP]NSIB].~IT¥:OFrtTHE APPL:CANT TO ASSURE THAT <br /> NECESSARY iNi::'ORN~TION:HAS ~EI:H PROVI:DEDi.,, ' ::: <br /> <br />J"L, AN ~'7'~ ';:" <br /> 1",[ 1.W, BY <br /> <br />F/EHARKS: SS:STD <br /> <br />'f']: Of',l: BY ................... DATE ................................. <br /> <br />FORM # MC 16.§$ R~. 4i~0 OFFICE COPY <br /> <br /> <br />