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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 />JOHNSrJN~ B~J'.LLY ~,.; <br /> <br /> 2~,3g NAI'~Q~AL CT 8E ~ ................................................................ <br /> SALEH, O~ 9'238t ~ SITE NUmBeR: ~-~7~2 <br /> PHONE: :~64.-5458 <br /> <br /> I58 ~ 522 1.8.i, AC <br /> <br />TYPEt O~-SITE SEtlA~E <br /> <br />Salem: 97~07-0000 <br />PHONE: 588-1115 <br /> <br />5100~ <br /> <br />WATER SUPPLY: PW <br />TEST HOLE8 REAQY= <br />~TE EVALUATION NUMBER: tJJS? <br />EXISTING TANK SIZE: <br />~×IS~ING ~RAI~ FIEL~ LINES: <br />SEPTIC TANK PUMPED: <br />PREVIOUS NO."BEDROQ~S~ <br /> <br /> I TE~ [IUANT I TY A~OUNT <br /> PR£$~URE DISTRIBUTION ,' 1 <br /> <br /> : ' .... ' TOT'A~.' A~E$SED.'.FEES <br /> · ...... ',' ..... : P~,VlOUS RECEIPT9 <br /> · .., '. '.:.;. .'., :.;..: :' <br /> <br /> PAYEE. . ~ -.,, · . .... ...,,,...:..-...~ ..... RECEIPT <br /> RECEIVE~ BY: MB ~.J~ -~c".-:' ""';'~ ;,'";"""""'~ ....... ~ Y 'TYPE. CHE~K ~: <br /> ~EE ATTACHES 90~U~ENT .',FQR...BE~Ut-RE~Efl,T~'.':O~ ,ON-S~TE "~AGE <br />, · TH;5 IS A VALID PERHI~ i',,,.'TH~S'~iT..EXp~RES.~3~ ~ F~H ITS ISSUE DATE. IF <br />~QIqSTRUC'rlo~/ FAILS TO MEET,,,"nEL RE'QdlREHE~,',OF~'S'TATE .~W$ AN~ MARION COUNTY ~UIL,~ING <br />~ONIMG OR~INANCES~ THIS PERMIT 8HALk: BECOME' NULL .AND-VOID. <br /> <br />~ONAL~ E. WOODLEY~ HARIOM COUNTY BUILDING OFFICIAL / BY' <br /> <br />FOaa ~ ~ ¢-,~ -~'. 4,~ OF FICE COPY <br /> <br /> <br />