Laserfiche WebLink
MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: ~88-5147 8:00 - 4:S0 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />I am performing§ work on a oroperty I own or OCCUpy, <br />f am a registered builder OR ( ) the authorized represeotative SIGNATURE OF APPL CANT: <br />of 8 rog~stered builder. <br />The work will Se performed by 8 registered builder, <br />Other <br />I have read and agree to me terms stated on the reverse side of DATE; <br /> <br /> ........ ~ '~ .... <br /> <br /> le920 HAI~-r"[N I.,.N NE <br /> ~[,~R01~ 0R eTee2 ER~T ~NT~'"' ~; 'OCCUPANT LOAD: <br /> <br /> ALOHA OR 97e87 SITE HUN~ER: <br /> PNOHE; 678-~286 V~LU~I'I ON~ <br /> <br /> TYPE: ON-SITE SEWAGE W~I'ER SUPPLY: <br /> 'rEST N8LES <br /> PERMIT OR APPLICATION NO: 5536~ SITE EVALUATION NUMBER: 5~35 <br /> EXISTING TANK SIZE~ <br /> CONTRACTQR,, NO~ EXISTING DRAIN FIELD LINES: <br /> SMIll't~ ALAN SEPTIC TANK PUHF'ED;: <br /> r','O ~['~X 6779 PREVIOUS N0. BE~I~0OMS: <br /> ALOHA 0R <br /> , HON~.',. 67R-;5286 <br /> <br /> iTEM QUANTITY <br /> ~ ..... <br />STANDARD ON'"'G II'E <br /> <br />TOTAL ASSESSED FEES <br />PREVIOUS RECEIPTS <br />Tt IS RECEIPT <br /> <br />BALANCE 9UE $0,. (~ <br /> <br />PAYEE: RECEIPT <br /> <br /> ~:.CI:,WE.D ~Y,," P~ TYPE: CNk:CK ~r, 0 <br /> <br /> SI:;E A'i"I'ACNED DOSIJMF'I'I1- FUR kI..LtUIREMENTS OF ON-SITE cE. WAGE SYSTEM. <br /> <br /> THIS IS A VALID PERMIT { THIS PERMIT EXPIRES 360 DAY8 FROM ITC ISSUE DATE. ~F <br />{;O[,~S~RHCI'TON FAILS lO HEET ALI.. :REQUIREMENT5 OF STATE LAWS AND MARION COUNTY BtJILI).[NC <br />ZONI;N(~ ORgI. NAHCES~ T,-IIS PERMIT SHALL B~COME NULL ANg VOI9, <br /> <br />,'*f.MAl',hc,,, N[!:W ,,,LPT.,.C <br /> <br /> COi. INTY :SUIt.,,~DINI; OFFICIAL / BY <br />I)0NALD E, W00.0LEY~ i'4ARIOH ' <br /> <br />x OFFICE COPY <br />FORM ~ MC 15,,56 REV, 4Jt)o <br /> <br /> <br />