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MARION COUNTY BUILDING INSPECTION <br />SENATOR 8LDG, NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 9730t <br /> <br /> PHONE: 588-5147 8:00 ~ 4:30 <br />24 HOUR'CODE-A-PHONE: 588-7904 <br /> <br />~I~NA~J~E OF APPLICANT; ........................................ <br /> <br />OATE; <br /> <br />17558 BUTTK¥ILLE RI) . N£':' <br /> <br />: RESIDE'NTTAL <br />occUPANCY; <br /> <br />TYPE: QN--SITE SEWAGE I WATER SUPPLY <br /> ~ TEST HOLES READY: <br />PEEMIT O~ APPLICATION HO; 9G52~2B i SITE EVALUATION NUM~ER: <br /> | EXISTIHG TANK ~[ZE= <br />CONTRACTOR~ <br /> ~X~STING ~RAIN FIEL~ LINES~ <br /> <br />19546 ~UYTEVILLE RD :M~IN RES I ;.~ <br /> <br /> [TEH ,~: ,-/" ~UAMTITY <br />ANNUAL EVAL. - TENP O~i 1 <br /> <br />RECEIVE~ BY: CL <br /> <br /> GEE ATTACHED OOCUHEHT <br /> ~ THIS IS HOT A P£RI'IZT~. <br />FOLL. OW~NG HU~T BE COMPL, E <br />ALL NECESSARY INFOR~ATI[ <br /> <br /> F,.-..~*,~ c,:' T ,*. ..:.... <br /> <br />AMOUNT <br /> <br />$0.00 <br /> <br />~0.00 <br /> <br />REVIEW PROCESS WHERE THE <br /> APPLICANT TO ASSURE THAT <br /> <br />BY DATE <br /> <br />FO~M # aC ~r~ Pi[V, ~ OFFICE COPY <br /> <br /> <br />