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MARION COUNTY BUILDING INSPECTION
<br />SENATOR BLDG, NO, 225
<br />;:'20 HIGH STREET NE
<br /> SALEM, OREGON 97301
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<br /> PHONE: 588-5t47 S:O0 - 4:30
<br />24 HOUR CODE-A-PHONE: 588-7904
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<br />¢ GNATURE OF APPL OANT: ....................
<br /> DATE; .......................
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<br />WATER SUPPLY." PW
<br />TEST HOLES READY:
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<br />~X~BI'IN~ T~NK SIZE:
<br />EXISIING ;DRAIN .FIE~.D LINES;
<br />~[PT~C T~NK PU~PED~
<br />PREVIOUS NO. ~E~ROOB~:
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<br /> ITE~i ..... " . .... "," ' · · · ,", · QUA[qT'~Ty
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<br /> r_'xr. ~NG SYSI'EH EVAL. ~P~..'..,', , .' , .... .: ~
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<br /> 2 . .' . .: ":':' ',PRE~,O~' RECEIFITiS
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<br /> F'hYF;~ ,', "''.."''",. · ,,,' '. ,,' · '.'. , · ~ECEIPT NO~
<br /> ~,:C,:,,VE/) BY~ ~,,L .................. ;,,_~_.% ........ ~,,.L:..~_-:2,..'_'L.2_=g= .. ..... TYPE; CHECK
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<br /> ~ !~S IS ~ V~tB P~iT ~ --T~$.;PE~I~ EXPI~S 3~..DATS FROH tis ISSUE ~ATE.
<br />CS~$~ ~U[~3':LD~ ~t~ '~'~ ~E'ET AE[ ~EQIJIR/~[~T$ OF,STATE. LAWS A~ HARION COUNTY
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<br />OFFICE COPY
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