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MARION COUNTY BUILDING INSPECTION :::',:i:{~:: , <br /> SENATOR BLDG. NO. 225 <br /> 220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> : : 'I ' I ' ' PHONE:5885147" 8:00J4':80 <br /> ' 24' HOUR: OODE--A'PHONE 588~7904 <br /> <br />i ~m a registered builder OR ( ) the authorized representetive SIGNATURE ~F APPL CANT: ..... <br />of m rerstered builder, .. , , ,, , ,, ,' <br />The work w II be pc(formed by a registered builder.' <br />Other , ' ' ~ ' ' ' < <br /> <br /> OW N E ~:-~-~') I~-'~-r~ ...... ~/~-- .... ~'~ 1 [.~ <br /> <br />~ _LJ~5~!-MA N ~_E~ ......... ~ ....................... Z~5~ .............................. <br /> 81TU~ ADDRESS: ~ CONSTRUCTION TYPE; <br /> ~ AIJHoV[LLE FIWY' SE CONTRACT CITY'. T <br /> <br />~[ o~ BU~LmN~: ' ' <br /> <br />3015 STARR CT NE <br />SALEM OR ?7303 94-01912 <br /> <br />OATE-G-61~ ~ <br /> REEI~EB,IIAL __ <br />OCCUPANCY: <br /> <br /> SUSDIVJSION; <br /> <br /> ~ SITE NUHDER: <br /> __ .1, VALUATION: <br /> <br />965 ..~,A~ ............. ~ ................ <br /> <br />TYPE; ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONTRACTOR, NQ. <br />USSELMAN, G. & FI. <br />3~15 STARE CT NE <br />SALEM OR 9730~ <br />PHONE: 588-0~99 <br /> <br /> ITEM <br />SITE EVAI. UATION~ lEA. <br /> <br />PAYEE:. <br />RECEIVED BY: PB <br /> <br /> i WATER SUPPLY: PW <br /> J TEST HOLES READY: YES <br /> 550~4 I SITE EVALUATION NUMBER: <br /> ~ EXISTIN(; TANK SIZE: <br /> I EXISTING DRAIN FIELD LINES: <br /> .,~,,~ .,,,,~,~ ~.~ ~ :~,: o,,., ,,~,,,~; .~,,:,~:¢ ~-~¢;~[~;,~,~J,M F ED, <br />~_ PREVIOUS NO. B~DROC)HS: <br /> <br /> :,: QUANTITY AMOUNT <br /> <br /> : F~:ES $22r% <br /> :'TS $225 · <br /> <br /> RECEIPT NO: <br /> TYPE: CHECK ~: 0 <br /> <br />SEE A'FTACHED ~YSTEH. <br /> <br />NOI'E: TFIIS DOES NOT <br />ONSTI~UCTIOR PERHITS <br /> <br />THIS PARCEL. PLANNING AND <br /> INSTALLATION BE(;INS. <br /> <br /> <br />