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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLOG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 6:{30 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 ,,-- ~ .~_~..- . <br /> <br /> have rea,~ and ag,;;~'"to~I}erms stated on the rever~e 8irle of DATE; <br /> <br /> QA'f'E; 121~/~4 TIME: <br />.~ 6~[DHHSON~~ ~ ......................... ~-~-C5~ ................... ' ' <br /> <br />" AUMSVILLE OR 9732S <br /> <br />TYPE: ON-SITE SEWACE <br /> <br />PEP,~IT OR APPLICATION <br /> <br />CONTRACTOR, <br />JOI4N~ON~ GLORIA <br /> <br />PHONE: 74~-2354 <br /> <br />WATER ~UF'PLY; PW <br />TE~T HOLES READY: <br />~ITE EVALUATION NUMBER: <br />EXISTING TANK ~IZE: <br />EXISTING DRAIN FIELD LINES~ <br />SE?T~C TA~K PUMPE~= <br /> <br />9B&~14! <br /> <br /> ITER · '' m 'I ' ~''" ' QUANTITY AMOUNT <br /> EXISTING SYSTEM EVAL. ~PT, '".I mm <br />~ THIS iS HOT ~ PERHiT. ~T~zs ~PPL'~CA?II~ HU~T GO T~OUGH h ~VIEW PRO~S ~HERE THE <br />t:OLLOW~HG HIJST ~E COMPLETE~', ;.;IT:i,,',I$"~HE.'..,',.RESPONSIBZ'LZT~ ,OF THE APPLICANT TO ASSURE THAT <br />~I.L NELESS~Y [NFOEHAT[ON: HAS =~EEN."P~O~Z~ED. "' '; :. ': ' '.- -'.. <br /> ( ':"," , ?. ,' <br /> ~ ~ ~, ~}r"' "L: ~'.,',..~. ,~ , · ~' : ,, . .,-~.':..:., <br /> <br /> E~E *~NEED PUMPER FORM t2-q~94 <br /> <br />OFFICE COPY <br /> <br /> <br />