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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. NO- 225 <br /> 2;20 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 /> t ~m a ~e~;llstered builder OR ) the auttmrized representative $1GNATUIi~e OF APPUCANT; <br /> <br /> o ~ "~',~' ~': ',' ' "~',"";' =,, "j ",=.' ' ~...' · <br /> I nave read a~ agree o the retina 8~atSd On the reveme side of .:= :". ~." ::,'-'~ ~ ~ ~ I~ ' '~",' ' , <br /> h s ~o~e~ .... ? .. , :~;.""..:.~'~-~..~'~j-~ .'1:~ '.."; <br /> PATE. ]2/~6/94 T[HE= 15~13~32 '.'.'-' .'....'~'.~':~,'.~ ': ~¥' ', <br />~.~.. · ......................................................... ~ ........ ,-;... ::... .:.....~... ;':.. ..,.~~ <br />· ....................................................... ').'? :""' ...... ...:,, <br /> zT~ z~T. ~L S~--~ :'":~' ;:"'~"'"';' <br /> - , ' .. ,, .'..... -':L..~;":'~'~..~~'~ <br /> hUHSV~LL~ ~ ~7~2~ , , ~;~,.~,:~.::~.~-~ ,,.::~,.~y~:~.~:.=..,::-....': .' .... <br /> k;~~ ........... <br /> <br />KIN ALL£N <br />52B1HOHELL PRAIRIE RD NE <br />PHONE: 87~-1144 <br /> <br /> TYPE~ ON~ZTE SE~E I. ~ATEE ~UPPLYi <br /> TEST 'HOLE~ <br /> PE~iT OR AP~ICATIDH ~ .~6~ SITE ~AEUATZON HUH~ERs <br /> EXISTING <br /> T~NK <br /> SlZEa <br /> CONTRACTOR, NO. ~_ <br /> EXISTING DRAIN FIELD L~HES: <br /> ALLEN. KEVIN ----~ ~ ~ ~EPTIC TANK PUHPED: . <br /> PHONE: 873-1144 :'. <br /> <br /> ZTE~ .... ~ -;,'~ GURNTZTY ~QUNT <br /> <br /> PAYEE= ~IN YOUNG~ RECEIPT NO~ 62682 <br /> RECEIVED BY= ~F ~,~,,TYPE~ CK CHECK ~: 346~ <br /> gEE Ail'ACHED ~YSTEM. <br />~ TH~ IB NOT A THE <br />FOLLOWING ~UST BE THAT <br />ALL NECESSARY <br /> <br /> OFFICE COPY <br /> <br /> <br />