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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 /> 24 HOUR CODE-A-PHONE: 588-7904 ~ <br /> I am a registered builder OR the authorized representafJve SIGNATURE OF APPLIS <br /> <br /> The work will be performed by a registered builder. <br /> Other <br /> I have read and agree to the terms stated on the reverse side of D <br /> this deeument. <br /> <br />~ OWN'~ b: TAX LOT: CATEGORY: <br /> <br />CONSTRUCTION TYPE; <br /> <br />~OCCUPANT LOAD: <br /> <br />!MAILING ADDRESS: "~O'~i~)i~iOg': ............. <br /> <br /> ~ <br /> <br /> I][(..,J_,, 4/.,.. ,~ ...... <br /> <br />TYPE: OH-SITE SEWAGE <br /> <br />PERN'~T OR APPLI,CA, TION <br /> <br />4,6_ d.,,,.~;iDL. 1)~ <br />MCN:I,H~V;N,,I.,E~ ~l:~ 97]28 <br /> <br />WA'Y';iR SLPPLY: FmW <br />TEST HOLES READYI: YES <br />SITE EVALUA'¥'IOH NUf~BER: <br />lEX },S'I' };NG TANK <br />EX:ES-FING DRAIN FIELD <br />SEPT]:C T~NK I:'UNPED~; <br />PREVZOUS NO. ~EDROO~S:: <br /> <br /> I '[ [..~ <br />S'['1'~i:; ILVf'~L_i.Ja"~ I]OJ'4,~ FIRS I' LOT <br /> TOTAL ABSESSED FEES <br /> PREVIOUS t:~ECE P-FS <br /> THiI. S <br /> <br />[fl LL,, ~)¢'V.l.:t)~OI,,~ JOHN ,~E,C],.,F,,~ ? NO~ 56950 <br />RF '}F:'TV':t) ~Y. c'l .................................................................. TYF'E: (]K C,H..bx ~l~: S9°8 <br /> <br />FORM # MC 184(~ R'~4. 4/9o OFFICE COPY <br /> <br /> <br />