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.¢ <br /> <br />MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br />~ALEM, OREGON 97301 <br /> <br /> PHONE: 588-St 47 8:00 - 4:30 <br />24 HOUR ~CODE-A-PHONE: 588-7904 <br /> <br />I am pedOl'ffilng work on a IDtOCedy I own or ~py, <br />I am a registered builder OR { the authorized reDresentalive <br />of a regletered builder, . <br />The work will be pe~ormed 0y a r~istered b~tJder,' <br />Other~ , <br /> <br />OATE: .................................. <br /> <br /> FI ,L <br /> <br />OCCUPANT' I= 0AD'. <br /> <br />~mTsuooiv~s~o~ ....................... <br /> <br /> PO BOX ~5~ <br /> AUROR~, [JR. 97002 I SITE i~J~fBER= 94-g2$~a <br /> PHONE. &TS 1472 , [ VALUATION: <br /> r I , ............ T .... <br />....... ~ ~,, · . ~ ~ ~ ~ .... ~ ~ ........................ <br /> <br /> TYPE= OH~IT[ SE~gE' · ! 'l ~ATER SUPPLY: CN <br /> PERHZT OR ~PLICAT~DN ~: 9~5~ I TEST HOLES READY:' <br /> ~ SZTE ~ALU~TZON <br /> CONtRaCTOR. NO. , , , j J EXISTIfl~ DRAIN FIELD L~ <br /> AUTH~E~ZAT~ON NBT~CE: ~ <br /> <br />$160.00 <br /> $0.00 <br />$160.00 <br /> <br />~,:~ INVOICE NO: 59~.J4 <br />:.~ TYPE: IN CHECK ~: 0 <br /> <br />PAYEE= JESKEY, I <br />RECEIVED ~Y:' MB <br /> <br />SEE ATTAC~{E~I <br />~ THIS IS NOT A PERH] <br /> <br /> RE'fIE~z PROCESS WHERE THE <br />FOLLOBINI; MUST THE APPLICANT TO ASSURE THAT <br /> <br /> F'LAN <br /> REWE~: <br /> <br /> OFFICE COPY <br /> <br /> <br />