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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 />The work will be performed by a re~istered builder, <br /> <br />: OWNER'. ~ TAX LOT'.. <br /> <br /> S',]~ ,L Ecl" ER SY -- : CONTRACT OirY: : UGS: ,OCCUPANT <br /> DETROIT OR 97342 DETROZT ~,.10 ! <br /> <br />,FUS~ OF B~LD NE'. = ' NO OF BEDROOMS <br /> <br /> CL..ESTER <br /> <br /> ,,,At.I::~:) OR SITE NUHBERI <br /> , H Ail. ,~7,.--6,~o., ~ VALlJAT];ON: <br /> <br />TYPE: ON-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION <br /> <br />CONT',-~ACTOR, NO.. <br /> .... : .... <br />,P~O SA[E~ t,,IEI{;HTS AV S <br /> <br />FHOME': <br /> <br />WATER !SUPPLY: <br />'TEST HOLES REA.D,Y: <br />S..IE EVALUATIOi,~ NUMBER: <br />E, XISTIN6 'TANK SIZE: <br />EiX:fSTING DRAZN F'IiELD <br />SEPTIC TANK F'UMF'~B:: <br />?RE'VZOtS ldO. BED~'d2OKS: <br /> <br />:t:'TEH ' :' T .... QUANTI'TY AMOUNT <br /> <br /> : 'i'OTAL AsSEssEB F:~ES $160,80 <br /> :~REVI[ tS RECEIFTS $0,,80 <br /> <br /> : : $0.00 <br /> TY~ E,, ;N CHESK :~I,: <br /> <br /> , <br />'"': "" ~ ' E CZTY ,JURZS~ICTZON= BY ..................... D~'f'E <br /> <br />FORM ~/MC 1 ~-,16 REV, 4/~0 OFFICE COPY <br /> <br /> <br />