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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 buMder OR the authorized representative <br />Other <br /> <br />OATE: <br /> <br /> CATEGORY: <br />40S55--000 rd C~ J.D.::.N ~ ..A .. <br /> <br />Ai~R[II.;~; U~: 9'? r7, /;l :;.! H?~N]ZON C(]UNTY :NO <br /> <br />PO 90X 412 ~~ ~ <br />F'NONI;~ 678-.5(~78 ~ ~ V~LUATIOIq= <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PEEMFr OR APPLICATION <br /> <br />WOg~BURN~ <br /> <br />7057795 <br /> <br />WATER SUPPLY: F'W <br />TE'ST HOLES READY: <br />SITE EVAL. UATT. OI,I I,IUNi~{ER: <br />EX.'I;SI'INi-~ TANK SZ[ZE,~ <br />EXISTING ~RAIN FIELD L. ZNES: <br />SEPT];(; TANK PUMPED: <br />PREVIOUS NO. ~EDROOHS~ <br /> <br /> i"t' E:N QUANTITY ~MOUNT <br /> TO AL ASSEoSED FEES -' ,;.. <br /> BALANCE DUE <br /> <br /> S~SI{J A'~'TAC~{F!D DOCI.IiiENT ZOR RE.BtJ:[REi~EN'[S OF ON-SITE SEWAGE SYSTEM, <br /> <br /> ~ THIS IS NOT A ~ERMIT. THiS APPLICATION MUST ~ THROUGH A REVIEW PROCESS WHERE THE <br />~OLLCW~;NG HUST PE COHPI.]'TE<'D, , IT <br />¢~1../.. HEcESSARY INFORM~T'[r]H HAS ~E~]{f,I <br /> <br />FORM # t~C ~ e-se REV, 4./90 OFFICE COPY <br /> <br /> <br />