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MARION COUNTY BU1LDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: G88-5147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: ,588-7904 <br /> <br />have read and egree to the terms stsle'cl"on the' reverse s'i~e o~ <br /> <br />DATE~ ........................... <br /> <br /> 532~ NW <br /> VANCOUV~R~ ~A 98663 J SITE NUNB~: 94-~34~1 <br /> PHDNE~ 266,,.&~5-B~66 . VALUATION~ <br />;LOT: ........................................................................... <br /> <br />TYPE"- ON-SITE <br /> <br />PER)t;r OR A~'PLZCATION NO.' 5~475 <br /> <br />CON F~ACTOR. <br />JE~"F EEY~ CR~SE <br /> <br />PHONE= 2~6-695=~96& ;' <br /> <br />WATER SUPPL.Y~ <br />TEST HOLES READY: <br />SITE EVAL, UATION NUMBER: <br />EXZSTIN~ TANK SIZE: <br /> <br />~EPTIC TAN'K PUMPE:D: <br />PREVIOUS NO. <br /> <br /> ITEt4 · ) QUANTITY AHOUN" <br /> PFJRI~IT RENEi4At, NO VI$Ii~:' ' ' <br /> · : '.'." . .....:, ...... - ..... .: ..... . . 1 <br /> <br /> : ],....." .- . ,...,'.;' '.' '.. . · <br /> <br /> ..... " '"','"".'. .... "";:;' ' "'. :':.'..'.'"','t'."":' <br /> <br />CONSI'EUCTION F'A~LS TO ~E'E~ ALL RE~UIEEHEHTS DF ~TATE LAWS A,~ HARZON COUNTY BUILDZN[, <br />ZONZNG ORDINANCES~ TH~ pERHIT"SH~[L, BECOME ,,NULL AND <br /> <br />Rf..~;~,RKS=4,46[94.PERFLl'T ~E. NI-'W,Ai.: NO F/VL SEEPA~;E IRENCHE8., , REPL,ACES SITE ,~9;~/~h55 ANO F'ER~iJ'; <br />DONALD iZ, WOC,,IDLEY,~ ' ,, ' <br /> MANIO ,.COUNTY. BIJILDING; OFFICIAL. /~ .BY ................... ~ ..................... <br /> <br />OFF) CE COPY <br /> <br /> <br />