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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />2'PO HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00- 4:30 <br /> 24 HOUR CODE-A-PHONE: 585-7904 <br /> <br /> am per(ormJng wok on a p¢operty I own or occupy. ~ ~,~ ~ <br /> { am ~ regi~tered builder OR ( ) the aulhorized reOre$¢h~atlve SIGNATURE OF ApPUCANTt ~. ,,,~ ~. , <br /> Of a registered builder <br /> Other ' <br /> <br /> ~ ............................................................................ ~ ~ ......... ~ ..... . .................... . <br /> <br />~'~S' *bb~} ...................................................... ~~;-~: ................ :OCCUPANCY: <br />~UH~V~L. LE~e~7~ ~T~YTON R~ 0R 9732~E · ~~TY~ ......................... ~ .............. ~'~E~b.*~. <br /> <br /> .......... ~'~'~j~r~.o.~ ....................................... <br /> SAME ~ ........ <br /> .. s~ ~,~= ~ ................ <br /> PHONE= 759~4~7 [ V~LU~T~0N: <br /> <br />................. ~TOWNSHIP: ~ RANGE: I ZONE: t MAP: <br /> ~ EFU <br /> <br /> ~PE~ ON-~ITE ~AGE ~ATER SUPPLYI P~ <br /> TEST HOLES RERDY: <br /> PE~IT OR APPLICATION HO: ~ll~ SITE EVALUATION NUMBER= <br /> EXISTING TAMK SIZE: <br /> CONTRACTOR. ~0 I EX~STIHG DRA[fl FIELD L~NES~ <br /> <br /> PHONE~ 769~4317 <br /> <br /> ITEM ." ,, ~UANTITY <br /> REPAIR - MAJOR ":, l <br /> <br /> : "" '."."' ..' T~,L...,sS~sS~"r~S ~.~.~ <br /> · " . .". ::PRE~OUS:'RECE.~P~S ' <br /> <br /> ~ THIS ~S A VALI9 PE~iT ~", ,TH~ .pERHZ~' ExP~',~&~ '~AYs' F~O~ ITS ISSUE DATE. ~F <br /> CONSTRUCTION F~[LS TO MEET '~E~';RE~REMEN~, OF:' STATE'. E~BS AN~ MAR~ON COUNTY ~U~L~ING <br /> ZONING ORDINANCES, THI~ PERMIT"~HALE.:'~E~E .'HpLE'. ~D'.vo~I. ' ' <br /> <br /> ...... ,, :.':: ....,. ,,,:, : ".. <br /> <br />OFFICE COPY <br /> <br /> <br />