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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 H~GH STR~T NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE:588-5147 8:00- 4:30 <br />24 HOUR CODE-A,PHONE: 588-7904 <br /> <br />The work will be @ertormed by a regi8tered buiJder, <br />Other <br /> <br />this document. <br /> <br />S GNATURE OF APPglCANT ................................ <br /> <br />r~f?O-s' A ~ ¢ ~'~'s~ .......................................................................... '~'§Y~¥d$i~- 7TEA7 ...................... /~ccu~A~59: <br /> AURORA' ::" ; OR ~7ee2 - AURORA j NO j_ <br /> <br /> MAILING AODRESSI SM BOIVISION; <br /> <br /> 14~76 SW HART <br /> BEAVERTON OR 97~ SITE NUM~E~: <br /> PHONE: 644-.-58~7 VALUATION: <br /> <br /> .... ~'- ............. ' .......... ............ ~ .... <br /> <br />TYPE: ON-SITE SEWAGE WATER SUPPLY: CW <br /> TEST HOLES READY." <br />PERMIT OR APPLICAT~O~ NO; ' 9~52BEB SITE EVALUA'f~ON NUMBER: <br /> EXISTING TANK SIZE:: <br />CONTRACTOf~ NO. 4125~ ~XIST]?I(; ~RAIN FIELD LINES: <br /> O~tlryi,lpie Bra :~,:tr~ Associate~ ~r~ SEP~IC,,,TA~K, [;:UMPE~: <br />2487~ S~.~ Hart Rd :,:; PREViOU9 ~O, BEDROOMS; <br />Beaverton~ <br />PHONE: 6.44-'S837 <br /> <br /> ~AYEE: <br /> RECEIVED BY: ~B <br /> <br /> SEE ATTACHED DOCUMENT <br /> <br />F[]~,.,L 0 W '.l. Iq~:; MUST <br />AL, L NECiESSA~Y INFORMATION <br /> <br />!:: INVOICE NO~ 5451.1 <br />:!: TYPE: IN CHECK ~,: <br />~YSTEM. <br /> <br />~HE APPL~;CANT TO ASSURE; 'f'HA'l <br /> <br />BY .............................. DATE; <br /> <br />~M ~ ~C ~-~ ~V, ~ OFFICE COPY <br /> <br /> <br />