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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 925 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: S~8-G147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br />Other <br />I have read ~d agree to the terms stated on the revets~ ~de Of <br /> <br />SIGN^TUR8 OF APPi./CANT: ................ <br /> <br /> DATE: ....... <br /> <br /> AURBRA~ L1R i S![TE N[IM~E~.' <br /> PHOH~{: , ~ VALUATION: <br /> <br /> TYPE: ~H-~TE SEWAGE WATER SUPPLY: ~W <br /> TEST HOLES READY: <br /> PEEHIT OR APPLICATION NO= ; 5~731 SITE EVALUATION NUMBER= <br /> EXI~TZN~ T~NK SIZE: <br /> CONTRACTL1R~ NO. i EXISTING D~A~N FIELD LINES: <br /> <br /> P,O. BOX ~j4~ '~ ~ F'REVIOV~ NO. BEDROOMS: <br /> A[JRORA, OR <br /> PHONE: ' <br /> <br /> ~TEM '. ~UANTITY AMOUNT <br /> <br /> · .' .:.'.'.. ".' ')'; '.:..".".,: ~,~,~, :~ECEI,PT ,'",' '" <br /> ' ,.- , ," ' "¢;""; ,'::.;?L~: .:" :.'".,.' ~.":"'" INVOICE <br /> <br />6OHSTRUCTION FAIL~ fO NEET. AL'E~"REQUIREMENZS,'OF :SI'ATE'b'AW~,AND ~ARION COUNTY B( I_DtNfi AND <br />ZOi4ll,!(; OR~INANCES~ THIS PERHIT','SBALL, BEg0~E,.' NUEL AND <br /> <br /> REMARKS~ o- , <br /> oS; STD SYS I. <br /> ~ONALD F;. WOODLEY~ MARIO;;J.. COUNTY BUILblNG OFFICIAL / BY ; <br /> <br />OFFICE COPY <br /> <br /> <br />