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<br /> MARION COUNTY BUILDING INSPECTION
<br /> SENATOR BLDG. NO, 225
<br /> 220 HIGH STREET NE
<br /> SALEM, OREGON 97301
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<br />PHONE:588-5147 8:00 - 4:30
<br />24 HOUR CODE-A-PHONE; 588-7904 ~' "~ ~ '"')
<br />i am performing work on a property I own or occupy.
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<br />: ,,,,tl.I...,:~l.~,,~ h.,.,,~,,~ I., ,., ~ ...... L ~ ~ ~_~ ~ ..... I!, ~
<br />I,'~l~0~ A~b'R~i '. CONSTRUCTION TYPE: ~ OCCUPANCY: ,,,
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<br /> ']'~6'xl S'/I::TNK~P RD ~1: ~'5~'~i~ ~'~ ~ ~
<br /> ~ .... : ...... ~'"~' ~i'iARZOIq COVNTY INO !
<br /> .... H,,~ ,~L..L O:,< 97..~..,,~ i
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<br /> ........... ........................
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<br />'. :J6647 [;ZLF:EY RD ~
<br /> ,,~[o-'r~ ..... ('~ ~77;:;25 ~ SITE NU~ER:: 94-~4'3
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<br />TY?E: ON-SITE SEWAGE
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<br />PE~MtT OR APPLICATION NO:
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<br />..... c : " '.:;,'k Al Tc'-' ~
<br />~.~ ,.~,..J~, GI.E.,.I,I,, & ...... E .
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<br />SC1;O 01'~ 97Z25
<br />2HONE; Y28-.-~761
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<br />9~52~6~
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<br />WATI~ZR SUPF~LY: PW
<br />TE~T HOLES READY,,,,
<br />~]TYIE' EVALIJATIlO?( HUH~ER: 85.,,6,i~f;
<br />tEX:E~'T':ENG TAHK ~J'.ZE';
<br />EXIS'FIN6 DRAZN FTgI,,.D [_.~.N~iS~
<br />SEPTIC 'ANK
<br />F~F(E'v'ZOt iR
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<br /> F'REV:~GUS REC!~ pTS $~,,
<br /> BALANCE DUE
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<br /> SEE ATTACH;E!) I)OCUHENT FOR t~_.~U,[ ,EHMqTS OF OI,i-S:[]:E S~ZWAGE
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<br /> * THIS ~¢ NOT A PERMIT, TH~ APPLICATION MUST gO THROUCH A REVIEW PROCESS WHERE THC
<br /> A.,,~ ._ "~HAT
<br />FhLLOkIZ'J,i~; MUST zg 30~RDL{~TED. IT IS THE R[{SF'GNSIBZLITY OF THS APPLICANT 'FO cc ;,,~ ,
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<br />FORm # Mc ~5-5~ .~,.,,~ OFFICE COPY
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