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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 /> <br />I am a registered builder OR ( ) the autl~odzed representative <br />The work will be performed by a registered builder, <br /> <br />._ .LHI--'...j.[.,.../...t, ................ <br /> <br />CONSTRUCTION TYPE: <br /> <br />CONTRACT CiTY UGB <br />~ARZON COUNTY Il,fO <br /> <br />'us~. 6K dO'EiSFN'~: .......................................................................................................... <br /> <br />RESIDEhlT];~L <br /> <br />749'"20?? <br /> <br />SITE NUNBER~ 94-B;~78 <br />VALUAT];OI,I: <br /> <br /> ~OT' { 8LObK; ..................................... ! 2¢~ ~i~ ......... RANG~ <br /> <br /> ...................... ~ ............................. :k4 ....................8S .................... Z2.t¢ ....... I ....................... ~47 <br /> WIDTH; ~DEPTH: AE EA'· UNITS: IRREC LOT i CORNER; <br />....................... j ........................................ % ................................ ?2 .................... k !'Lq .................. <br /> <br />98§7956 <br /> <br />WATEI~ SUPPLY: PW <br />'I'EST HOLES READY: YES <br />SITE EVALUATION N, LiH]:4ER: <br /> <br />EXZ~.;T]iNG DI,4AIN FIELD LLqES:: <br />S~?~ZC TANK PUHPED: <br />PREVIOUS NO,. BEDROOHS= <br /> <br /> r/EM QUAI,IT]:TY A~ON,1T <br /> <br /> IOIAL AoSE;~oEB F .,.I...,, ~ ~,¢o. (~,¢ <br /> PREVIQ 1~ RECEIPTS $~),, <br /> <br /> ~fGk ~lqOE DUE ~f~,, ~) ", <br /> ~&Y~,.]...[,-,kER,; CHARLES ]<EC~.Z]-'7 N[[:l ....... 6~)481 <br /> <br /> SEF AI'TACHE~ I~OCHMLN1 FOR RE~g;RF. MENTS OF ON-SITE SEWAGE S~STEM. <br /> <br /> $ T~ZS ZS ~OT.A [E~T, THI~ 8P~LIGATIQN ~OS[ ~O fHRQM6~ A ~E~IEW?ROOESS WHERE THE <br />F'OLL.ON.[N¢; ,Hb~,T sE C3HPLEI'E;Q~ IT ;~$ THE RESFONSIBN..ITY OF rile APPLI(.,AI,P' TO ASSURE 'I~-.A-f' <br />At I. t,ii,ES,,ARY ikFOR~AT_.ON' HAS BEE, <br /> I <br /> <br /> FLA~,~ ~?hV[E~;' ,, . I)ANE.. CIIY JURZSDILflLH.. BY :)ATE' <br /> <br />FORM # MC 15-f8 EgV, ~ OF FICE COPY <br /> <br /> <br />