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MARION COUNTY BUILDING INSPECTION <br />'~ ' SENATOR BLDG. NO, 225 <br /> 220 HIGH STREET NE <br /> -" ' , SALEM, OREGON 97301 <br /> ' ~Hou~PHONE 5885147 800 430 ' ~ ..~,~ <br /> am er,ormin wok r er 2n )roccuo~OD~'A'PHON'E:5'~-7904 <br /> , P ' 9 Onapop y ow o PY, . ,., <br /> I am a registered bu{Ider OR ( ) The authorized represe~te, tive SIGNATURE OF APPLICANT: <br /> of a registered builder, <br /> The work will be performed by a registered builder. <br /> Other <br /> <br />WARO- H, flERNADINF ~RESI~)E,TIAL <br /> I CONSTRUCTION TYPE'. /OCCUPANCY'. ~ <br /> <br /> 1781.10LMSTEAI) Rb NE ~'~5~Y~i~? -~:~ 6~O~A~ C~'X6 <br /> AURORA OR 97ee2 ~NAr<ION COUNTY NO / : <br /> <br />1YP£: ON-SITE SEWAGE <br /> <br />PERMIT tlr APPLICATIi~N <br /> <br />CONI RACT0r, I: N0., <br />WARD~ M,, BERNADIME <br /> <br />PI'lONE: <br /> <br />53267 <br /> <br />WATER SUPPLY: <br />TEST HOLES READY: <br />SITE EVALIJATION NUMBER: <br />EXISTING TANK SIZE: <br />EXISTING DRAIN FIELD LINES: <br />SEPFIC TANK <br />PREVIOUS NO. <br /> <br /> ITEM QUANTITY AMOUNT <br /> TOTAL ASSESSED FEES -$~0. <br /> <br /> B~LANCE ~UE~ <br />PAYfZE: WAR~ M. ~ERNA~)IN~ ~,~7~.8 <br />RECEIVED BY:: cl ....................................................... TYPE: RF CNECK <br /> <br />SEE ATTACNE~) ~)OCUHE~T FOR F~'EQUIR~:~,~FNI'S O~- ON,--SII'E SEWAGE SYSTEM. <br /> <br />TH~S IS ~O~ A PERHIT. THIS:IS:'~ REFUNB ,90CUH~T <br /> <br />REMARKS,~ R:{FJN~) OF' PER,tIT 5,3265 <br /> <br />FORM # MC 15-5~ R~/, 4¢80 OFFICE COPY <br /> <br /> <br />