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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO, 225 <br />220 HIGH STREET Ni~ <br /> SALIEM~ OREGON 97301 <br /> <br /> PHONE: 588-5t47 8:00 - 4:30 <br />24 HOUR CODE.A.PHONE: 588-7904 <br /> <br />I am a registered ~SUlldei' OR ( ) tMe a~Jtl'~orlzecl repcese~tatlve <br /> <br />The work will be pe~Ormed by a regi$'~ered buttder, <br /> <br />I have read and agree ~o the terms st~'t~ ~n th'~ revef"4¢ $1d¢ Of~ <br /> <br />OWNER~ <br /> ZELLER, <br /> <br /> 7555 POET <br />AUt,?~,ViLLE <br /> <br />USE O~ BUILDING'. ' <br /> <br /> TINE= <br />VICTORIA <br /> <br />S)~GNATURE OF APPLICANT: <br /> <br />P_O_ BOX 1037 <br />~IJI~VIL, LE., OR 9'13~5 <br />PHONE: '740-~'i'13 <br /> <br />150 <br /> <br />IYPE: O~-~['T'E ~[WAGE <br /> <br />P~/~IT OR APPLiCAtION NO; <br /> <br />CONTRACTOR. NO_ <br />ZELLER. VIC'FORIA <br />P,O. 80X 1037 <br />AUMSVILLE OR 07325 <br />~H~E: '14~3713 <br /> <br /> ~.[ ¥'E NUt,IBER; 1043 <br /> ; VALUA'r I C~ ~, <br /> <br />: 25 8~ 2W ~ AR <br />201' 30150. ~ 3F : NC ~ NO <br /> <br /> HATER ~PPLY; ~ <br /> T~'r HOL~ R~Y; <br /> 32849 SI'I'E E~ALUA1'I~ NU~ER: <br /> ~i~'r1NG T~K SiZ~ 1000 <br /> <br /> SEPTIC T~K ~MPE0: <br /> PRE~i~ NO. BED~; <br /> <br />PAYEE~ <br />RECEIVED BY: CL2 <br /> <br /> ~JAN'FI'rY A~.OUNI <br /> ,, <br />~O~AL AE~E. SSEO.FEES. Seo_oo <br />PREVICU~ RECEIPTS $80,00 <br />THIS RECEIPT <br /> <br />BALANCE CUE <br /> <br />R~:CEi P'[' NO: <br /> CHECK At; <br /> <br /> ........................ Z: ................. <br /> ~ AFl'ACHeD DOCUMENT FOR REQUIRSNENTS OF 'ON;-~ITE <br /> THIS IS A VALIO ~IT. ~'. THI~ ~IT <br />~ST~TI~ FAI~ ~O.~E~/~.~ ~I~ OF STATE'~ ~O <br />Z~ING ~Ol~. IHI~ ~I~.'~ B~E NULL ~D VOlO. <br /> <br />I,IERARKS: 0RAiNFIL~O RgPAiR F~6505 8AND FILTER -REPAiR ~Y~I'Et~ ~ ~ <br />OG~ALD E. ~3BLEY, MARION CCLINTY BU.[LO[N~ CFF[CIAL / try ........................ ~ ............................... <br /> <br />RSR~ * ~C ~ ~.*,~ OFFICE COpy <br /> <br /> <br />