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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. NO. 225 <br /> 220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br /> <br />, .m ' . .o .,, , oXO..?., <br />I am a registered builder OR ( ) the authorized representative SIGNATURE O A L <br />dhfe~ ~/eogrLSfwel~geb~rdf%~med by a registered builder, <br />Other <br />I have read and agree to the term8 stated on the reverse side of BATE'. <br />this document, <br /> <br /> .... ; R~ ,...D .N ) .!. ~ ... <br />I,,::../.IL~..h~ I._¢,/,,~ , -" <br /> <br /> · "vp' ~ "' F COUNTY~ NO ' <br /> <br /> ~ WAL.i)G HILLS FF~[)~:~,F~ <br /> PHL)i'] E: ¢~, J -o A~,4 ~ VALLJ~T~ BN = <br /> <br />TYPE.' 81,I-STTE SE~A~-E <br /> <br />PERI"J:~.T OR APPL),CATIOH ND: <br /> <br />(?IT,A!_'.TOR~ l~h. <br /> <br />PH¢I,E'.:' ,:~,8 1J .( 5 <br /> <br />WATER SIJPPLY: PW <br />)'ESl' HOLES READY: YES <br />S]:TE EV~LUAI-;[Oli NtJM!~ER~ <br />EXZSTZNE T~IiK <br />EX).S'F:Lii(~ DR~N,I FZEL~ <br />SEPT]:6 TANK <br />PREV}OUS NO. BEDRGOMS: <br /> <br />,.~.l.l).. ~;;VALLIF.1T}Iq',(~ Eh, ADtlI..,, L.O'F <br /> <br />FOTAL ASSESSED ;EFS <br />I. RF.. ~ ~[)US RECEIP"f,~ <br />'f'H:~S RECEPT <br /> <br />BA¢, ANf, F, .~ UE <br /> <br /> !¢~ 22 ;'..; ,. <br /> $225 ,. %(') <br /> ¢~225 ,. 08 <br /> <br /> 5¢>95'? <br />CHECK ~: '.: 1827 <br /> <br /> NLYI'E:: 'NI~:S })Oil!i; liOT GRAMT OR LY PERH;(SSIOH TO ~UILD OX; TH:IS I A~ ........... ...., ,..,. ai~;[) <br />f'P.~SFF:;Lu'N'I{}N F:'I~iRME'FS OR SEPTIC ZNSTAL..LAT;[(:)I,~ N~R;i:h'~R. <br /> <br /> ":' 6::~'~:' ' ':' .- 2',-~) LUT --H/~EG};N P~HT)..N¢.~{, PROCESS THiS DATE <br /> <br />FORM # MC l~-~ R~Y, 4/~ OFFICE COPY <br /> <br /> <br />