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MARION COUNTY BuiLDiNG INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97501 <br /> <br /> PHONE: 588-5147 1 8:00- 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />The work wilt bo/performed by a registered builder, <br />I hh~orcea 4i't? egree to t~e te ms stated on the reverse side of ~ DAT~ .................... <br /> <br />i MAILING ADDRESS; <br /> <br />F'Q BOX 36:3 <br />]:DANHA OR 97350 <br />PHONE= 800'-'~825609 <br /> <br /> SITE <br /> VAI,..UAT I Ob <br /> <br />· NO <br /> <br />YES <br /> <br />TYPE: OH-SITE <br /> <br />PERMIT OR APPLICATION NO: 9051186 <br /> <br /> :[TEn <br />E.X],oTIN& SYSTEM EVAL. RPT. <br /> <br /> PAYEE~, C, LARK,¢ KAREN <br /> RECEIVED BY: CL, <br /> <br />FOLLOW:[H~ ~U~T ~E 60MPLETE~; ,'IT IS,THE',' <br />ALL NECEBSARY IHFORHATIOW HAS BEF,N <br /> <br /> WATER SUPPLYt CW <br /> TEST HOLES READY: <br /> SI1E EVALUATION NUMBER: <br /> EXISTING TANK SIZE: <br /> F-XISTZN§ DRAIN FIELD LINEiS: <br /> ~EBTZC TANK PUNPED: ~-14.,-~ <br /> F REV]:OOS- NO., "~SE~ROOMS: ~ ~ <br /> <br /> ~UANT ITY 1 <br /> <br /> FEES <br /> <br /> INVOICE NO: 53741 <br /> TYPE~; IN CHECK ¢: <br /> 'o Ti SEW ' '" <br />' MUS~,,~O' T~B~ A RE~IE~ PROCESS WHERE THE <br />$POI~SZ~L'.[TCY~;.gF THE ~FPL~g~N'r TO ~SSURE THAT <br /> <br />FL, All RIi,'.VIEW: BY , DAT],:,: _ <br />REMARKS. E,~'., F:'F ?-'-.1,4'-?3/EA~EHEN¥ ATTACHED <br /> <br />OFF~CE COPY <br /> <br />BI'FY JURIS;ICI'ION: BY ........................ DATE ............................ <br /> ? <br /> <br /> <br />