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MARION COUNTY BUILDING INSPECTION <br />SI;NATOR SLOG, NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON g7301 · <br /> <br /> PHONE: 588-5147 ' 8:OO- 4:30 <br /> 24 HOUR'CODE-A-PHONE~ 588~7S04.. ~~~ <br />I am pecfOtmin§ wSrk O~l a pro~etW I own o~ o=¢u~. ' <br /> <br /> I have'Yea: a~d agree to Ihe terms S{~{ad ~n the reverse'~e of DATE: <br /> <br />~U~R~ 0R 77~2 ," HARI~N C~UNTY NO ~ : <br /> :, <br /> <br />PHONE: 678-1857 / VALUATION~ <br /> <br />TYPE= ON-s/'rE SF_i~R;E ] WATER 9UPPLY: PW <br /> I'.TEST HOLES READY: <br />PE~HZT ~ APPLICATION NO= ~tl.~, ) SITE EVALUATION NUMBER: <br /> i EXiSTZNG TANK SIZE: <br />CONTRACTOR. NO, ) EX~ST/NG DRAIN FIELD LINES: <br />HATHAWAY~ PHILIP .... ....~ ~., .~J.SE~TIC ~E.PUHPED: <br /> <br />PAYEE: HATNAWAY~ PHILIP <br />RECEIVED BY"- CL ~{ <br />SEf~ ATTACHED <br /> <br />$125.00 <br /> <br /> $0. <br /> <br /> RECEIPT NO: 55732 <br />TYPE.. CK CHECK ~: 1085 <br /> <br />REVZEU PROCESS #HERE THE <br /> APPLI:AHT TO ASSURE THAT <br /> <br />MAJOR REPAIR ,~H:N~ FO~ GZ~N F~SlT, E '.~REPERATION <br /> <br />~o~ # ~c ~ ~v.,,,~ OFFICE COPY <br /> <br /> <br />