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MARION COUN'rY 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: 588-7804 <br /> <br /> I am parlors[ilO work on s proper~y I own or oCCupy. <br /> <br /> o · red stereo builder. <br /> The wOrK will De pedormed by e ~eglstered builder, <br /> Other~ , <br /> I have ~e~ and agree to't~ terms stated on the m~me side <br /> this do;ument. <br /> DATE: 12/~?/~4 TIME: 15:~1:14 <br />~n~LLEN, KEV[N <br /> . ..................... . ................. .., ..... <br /> <br /> 7732 75TH PL SE <br /> AUHSVILLE OR ~Z~25 <br /> <br />OATI~! ................................ <br /> <br /> KIN ALLEN ...... - ..................... <br /> S281 HOWELL PRAIRIE RD NE 97~81 SiTE HUllER= 94-~2173 <br /> J,. '' VALUATZON~ <br /> PHONE= 873-1~44 <br /> <br />~PE: O~]TE SEWAGE WATER SUPPLY: PW <br /> TEST HOLES.READY: <br />PERN~T ~ A~LICATI~ ND; 98&~ Si~E,EVALUATION,HUMDER: 55468 <br />  EXISTING TANK $[ZE~ <br />CONTRACTOR~, NO~ EX~STZNG DRAIN F~ELD L~NES~ <br />ALLEN~ KEVIN BEPT~C TANK PUHPE~s <br />KlM ALLEN <br />5281 HOWELL PRAIRIE <br />PHONE: 873-1144 ~ ,', <br /> <br />SAND FILTER <br /> <br /> PAYEE; <br /> RECEIVED BY; CL <br /> <br /> SEE ATTACHED DOCUMENT <br /> <br /> ~ THIS IS NOT A PERHIT~ <br />FOLLOWING MUST BE <br />ALL NECESSARY IHFORMATIO~ <br /> <br />, .'.' !;;.' QUANTITY AMUUNT <br /> <br /> $480.00 <br /> :-'. $488.88 <br /> x $0.00 <br /> $0.00 <br /> <br /> RECEIPT HO= <br /> CH~CK <br /> <br /> '.~ REVJE~ PROCESS MHEEE THE <br /> T,~E APPL[CANT TO ASSURE THAT <br /> <br />Pi_AN REVTFW: DY ........ ~)ATE ~ ' ~ ~ CITY JURISi)ICTION: BY ...... DATE <br /> ~,~., ......... ? .~. ~_~.:~.~ ? ,-';.:.. y..,:--..~:..,:,.:-.:.':,_.'. ,..,~::..-.. ::.:--. - ............... <br />REMARKS~ SAND FILTER ......... <br /> <br />OFFICE COPY <br /> <br /> <br />