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l~Rr ON COUNTY <br /> <br />NAI~ OF APPLICANT: <br /> <br />~r~ WA .Ts. ~ C~cK <br /> <br />ADDKESS OF PROPERTY: <br /> <br /> The applicanC hereby requests a winter water check and hereby grants <br />permission ~o representatives of ltarlon County to enter the above described <br />property at reasonable times for the purpose of monitoring winter water <br />levels. The applicant understands that winter water checks are made during <br />~he months of January or February, an8 during a winter in which normal <br />rainfall has occurred. <br /> <br /> Please return this application to Marion County Dept. of Buildin~ <br />Inspec[ion, Sena~erBuilding, no. 225, Z20 Hlah $~, NE, Salem, Or. 97301, <br />Teleph~,ne 5~8-5t&?. <br /> <br />SIGNATURE OF AFPLICAN~ .... <br /> <br />~IGNATUI~Z OF O~NE~, i~ 6TI~ER TITAN APPLICAN~ <br /> <br /> <br />