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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 performing work on 8 property I own or ocoupy, <br />I am a registered builder OR the authorized representative <br /> of a registered builder. <br />The work will be performed by a registered builder. <br />Other <br />I have read and agree fo the terms stated off the reverse side of <br />this document· <br /> <br />SIGNATURE OF APPLICANTz <br /> <br />OWNER; TAX LOT: ~ CATEGORY: <br /> <br /> DITTER H]:LL. TRACTS P~RCEL 2 <br /> <br />J('h'li~ff,( ii,!. <br /> 40'5 JAMES NAY <br /> <br />/:'HO N:,:: ~: <br /> <br />[JAI'ER SLiF'PI,.Y," PW <br />TEST HOLIES READY: <br />si'rS FVALUATION hIUMBER: <br />]-S×ISTINF~ TANK SIZE: <br />I:'"×ZSTING DRAIN F]:EL..O <br />SEP"f ]C TANK PIJMF'I£D'.' <br />PREVIOUS ,!0, BIEDROOMS: <br /> <br /> I'TE bi (:,~UAI'I'f ! T¥ <br />r'i'~'f'F: I;:,V"flt.,U~f"[OH,~ !':]:i:t:~F I._Of ;~. <br /> <br />TOTAL A,:,ol:oSE9 FEES <br />F~E ¢IOUS <br /> <br />,"fi f! ]:".: I~.EC[~: II::'T <br /> .I .1 I .) BY: CL. <br /> .............................................................. TYI ,. i¢141:i.C K <br />:,i;~:-'~'.: hf'FACHEJ) DO_:UMENT FOR REQU'[REMENTS OF ON,SITE SEWAGE: SYSTEM. <br /> <br /> 'f,, bOl:::':~ hi'. '," ;-I'::,flN'T 3R :I:;¢fI::'I..Y : ,:R rio I,ll' TO ~LIILD ON THZS PARCEl,. ~;"i,,,AJ,II',~.L~,I,t,- , .,: <br />....... ~' ' Itl, h~._...A .;3~ I. G. , <br />· . I I. ..[ [ . . [,: h~ f~: OY~'fh]:Ni~:l RFFORI!i: :~'IU:~_LDING OR S~-t'"T]:C ", '^' '-'" ' <br /> <br /> I,"/:4t.l:l R,: )~ -'"' '~ <br /> · r,:J...!, TU ~NY <br />,, h': r; ,.., , ~, ~ ,' ~-ir,.:;LD:~N i:OiJliTY BU,~LDiHG OF'FJ:CIAL ,,- <br /> <br />SAM') <br /> <br /> OFFICE COPY <br />FORM # MC 15-56 REV. <br /> <br /> <br />