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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-A~PHONE: 588-7904 <br /> <br />~ em performing WOfR bna proper~Y I own or occupy. <br />I afft & registered bstder OR ( ) the authorized repre$sntative <br /> <br />The wo~ will be ~dOrmed Dy e ~egiste~ed buiJder. <br />Other <br />t have read a~ agree to t~ ~erm8 Staled on the reveres 3ida Of <br /> <br />! .¢~rU:~-~66~g.~= ...................................................... <br /> <br />MAILING ADDRESS: <br /> <br /> DA'( PI4~,HE : CHAD 749-'£82~. , <br />, ~ HO ,:.. 749-i~26 VALUATION: <br /> <br />[ ......... [ ................. ~ .... · _;.. ~ ....... ~ ........ ~- ' <br /> <br />TYPE: 0N-SITE SE~AG~ <br /> <br />PE~HIT DR APPLICATION NO: 9G5~85 <br /> <br />CONTRACTOR, NO. <br />~,[~t;H~ CORIE & CHAg <br />DAY FHONE ~ CH~ 747-1G2~" ......... ' .... <br /> <br />PHONE: 749-i~26 .. <br /> <br /> WATER SUPPLY: PW <br /> TEST NGLES READY: <br /> S~TE EVALUATION NU~ER: <br /> ~X~ST~NG TANK SIZE: <br /> ~XISTING DRAIN F~ELD LINES: <br /> SEPTIC TANK P~BPEDj <br />· PREVIOUS NO. DEgROONS: ~ <br /> <br />A IT4ORIZA1TON NO'/ICE "" ~ ~UANTITY A~OUNT <br /> ',TO'T~L ASSESSED F'EES <br /> <br /> ' ' '"'""-~'~NCE ~ '"' " <br /> <br />SEE ATTACH~I) DOCUHENT EDR.:.RE~UIPJEMENT~'DF· ON-~ITE".$'EW~'E.. sYSTEM. <br /> <br />Fo~ # Mc ~-~ ~. ~ OFFICE COPY <br /> <br /> <br />