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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHON~E: 588-5147 8;00 - 4;30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am a registered builder OR ) the authorized representative <br />of a registered builder. <br />The wodk will be performed by a registered builder, <br />Other <br /> <br />this document, <br /> <br />SITUS ADDRESS; CONSTRUCTION TYPE: i OCCOPANCY; <br /> <br /> ~ AUHSVI:LLE I,,IWY SE ~ARIOl,t COUNTY¢~ <br /> AtJ~SV];LL.E DR :~7~25 NO <br /> <br />MAILING ADDRESS; ~ ~ SM ~DIVI~ION; ' <br /> <br /> ,~815 STARR Cf NE ~ <br /> SA.SM }R ~7~8~ , ~ ~ITE HUHBER~ 94-81911 <br /> PHOHE~ [588'"-8.~99 i k VALUATION: <br /> <br />TYPE: OH-SITE SE#AGE <br /> <br />PERHIT OR APPLZCATiOH NO: <br /> <br />USSELMAN~ G. & H. <br />3815 SI'ARR CT NE <br />SALEM OR 97383 <br />PHONE: 588-0~9 <br /> <br />PAYEE: <br />RECEIVEB BY: PB <br /> <br />SEE ATTACHED <br /> <br />NOTE: THIS DO[;S NOT <br /> <br /> WATER SUPPLY: PW <br />~ TEST HOLES READY: YES <br />I 558~2 SITE EVALUATION NUHBER: <br />I EXISTING TANK SIZE: <br />I EXISTING ~RAIN FIELD LINES: <br /> ,.~EPIlC TANK PUMPED. <br /> <br /> SITE; B:VAI..UATION~ FIRS.T ::: i <br /> <br /> REOEIPT <br /> TYPE: CHECK ~: <br /> <br /> N THIS PARCEL. PLANNING ANI) <br />ONSTRUCTIOI,I PE:RH,[TS OR,"SEPTI6 INSTALLATION <br /> <br />FORM # MC t ~-58 REV, 4/~o OFFICE COPY <br /> <br /> <br />