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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 />I sm performing work on e proper~y Own or occupy
<br />I am e resIstered bu Idef OR ( ) he author zed representat Ye
<br />ol a registered builder.
<br />The work will be Oe~forme~ by a registered builder.
<br />
<br />SIGNATURE OF AI~I~LICANT: ........................
<br />
<br />DATE: ...........
<br />
<br /> : T~ LO~ ~ CATEGORY:
<br /> '~b-~g~: ........... RAg
<br /> ~ OONS~aU~ION TYPE: ' ............
<br />
<br /> ~ 3.~ 9~:TR~'[-r R~ · -- t ~.~..c~ c~=~: ....
<br /> ~ ~,=TRD~.T BR 92'342 ~ ~TRD[T NO
<br />~g ~-~b'fL~i-~ ................................................................................. , .........
<br />
<br /> ~ETRfl~[ LAK
<br /> PO ~OX 9~9 ......... "~ ..................................
<br /> AUNSVILL~ OR ~7~52 SITE HUHB~:
<br />m PHONE: 749-%7.52 V~LU~TION:
<br /> · [ ' .......... T ,,
<br />~o~ ................... ~'~ .......... ~'7 .... ~g~'i~ ~ ~'~'~ ...................... Ta';/,,'
<br />....... ~-- J I ~ . J,_sF ............. m_~ ......... !_.~5 ......
<br />~D~N~ .... ~H: .............. A~aA ........ ~ UNrT~ ' -- , m~a. LOT: ~ CO~N~; ' ' '
<br />~ 23~; ~ ISa '-'~- ' ; '
<br /> ~5~b~. I NO ' NO
<br />
<br />TYPE= ON-SITE
<br />PERHIT OR APPLICATION NO:
<br />
<br />ROUND,, ;~t V~N & ~ j,l~ .E
<br />Pf~ BOX 98~ , :-..' · ..: ..........
<br />~UHSV[U._E OR 97',]32 ""
<br />
<br />"WATER SUPPLY: C~
<br /> TER'F HOLES RE~DY: YES
<br /> ~ZT£ EVALUATION NUMBER:
<br /> EXISTING TANK SIZE:
<br /> EXISTIN~ DRAIN ~IELD
<br /> SEPTIC ~ANK PUMPED:
<br /> P~EV~US NO.'"BEDR~OM~
<br />
<br /> I'i'E.N ' · - ................................
<br /> SITE F{VALLfATION, FIRST. LOT' ' ,. [1UANTITY A~!OUNT
<br />
<br /> ,' ~OTAL. AO~ES~E~ .FEES $265.
<br /> · :"'"-= '." ';-' · "", :, · P~EMZ,OUS ~ECE~PT~
<br /> .................,,, . , ".......TH~S_.REgE~PT... · ..... , ,,
<br /> ...........
<br /> :..,,., ,,': :, ,, ,,, }.:~"'~:~ E":'~a~ ". ·
<br /> ~F:CEIV~TD ~Y:' ~F' · ' ""'" ":"'" © '""":'"'" "" '''/: INVOICE NO: 6~.~,~2
<br /> ................................. ~ .... . .............. ._ , , TY
<br /> SE ..... ' m ..' ~" ', ~ ~ :-q ...... .~---rv~z--~--~ ................ Z .........,"
<br /> ~ A~TALHED DO..U~F~NT.FOR..R~UiRE~NZS..O~.ON~SZTE..S/WA~~ SYSTEN. ' ................
<br /> .............................. 7., ...~7-~.F~-f~7:-~-','- =- ~-~-~ ................................................
<br />
<br /> . I~UTE:~ .... THIS DOE9o .... NOT [ lA ~T:'O~' ~'~2Y :'PE~.ZSS'ION TO "BUIL9' '"0~" T~IB P
<br /> ,,1_1~
<br />
<br />~ ~ ~ r .~ ~ ......
<br /> OFFICE COPY
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