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MARION COUNTY BUILDING INSPECTION <br />SENATOR E~LDG. NO. 22:5 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR'CODE-A-FHONE: 588-7904 <br /> <br />SIGNATURE OF APPLIGANT: ...... <br /> <br /> DATE:,,, ~ ................... <br /> <br />...........................................................: -fA~'LYrl ................... ,[ CATEGORY, <br /> ~ CONTACT CI~; j UGS: ~ OCCUPANT <br /> <br /> 'H~CK~Y CRE[K ................................................ <br /> SITE ~= ~4-a21~9 <br /> <br />TYPE~ 0N-SITE <br /> <br />CONTRACTOR~ NO, 8~74~ . .: <br /> <br />§7S93 <br /> <br /> W~TER BUPPLY: CW <br /> TEST HOLES READY: <br /> SI3E EVALUATION NUHBER: 55521 <br />· hE.XISTIN~,~RA,~N FIELD LINES~t <br /> SEPTIC TANK PUMPE~: <br /> PREVIOUS NO. BEDROOMS: <br /> <br />R~:MARKS: STD SYS'TEM '" <br /> <br />DONAL]~ E. WOO),)L, EY,~ M~R'tOW :'COUNTY -BU~LDIN~':OFF!'DI~L" 7"B¥,""_ ................................................. <br /> <br />FORM ~ ~c ~ ~ ~V, 4~ OF FICE COPY <br /> <br /> <br />