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MARION COUN'FY BUILDING iNSPECTION <br />SENATOR BLDG. NO. 225 <br />:~20 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-514,7 8:00- 4:30 <br />24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> I am ~, registered builder OR ( } the &utl~ort%ed <br /> of a registered builder, <br /> The work will ~e ~e~o~e~ by a teg{eteted bm~er. ; ' ' ' <br /> Othe~ ,, , <br /> I have re~d and agree to the terms s~t~ O~ the r/vl~e ~de of OAYE~ ................................. . · , . <br /> <br /> _ . .............. . .... . <br /> AUHSVILLE O~' <br />~ ~"~E~T~ ' ' T ~ L ........... ............. <br /> <br /> CONTACT~ 769-23~2 ~TE ~= 94~9 <br /> PHONE= VALUATZOfl= <br /> <br />TYPE= ON-SITE DEkL~;E <br /> <br />CONTRACTOR~ NO. 457~a <br /> <br />STAYTON~ 9738~ <br />PHONE: <br /> <br />STANDARD ON-$'rTE SYSTEF~ <br /> <br />SEE ATTACHEI~ OOCUNENT <br />· THIS Is n VAt. Ii~ I~B~ i <br /> <br />CONSTRUCTION FAILS <br />ZONING ORDINANCES, THIS <br /> <br />~;IGNATURE OF APPLICANT: ............................................ <br /> <br />WATER SUPPLY= PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMDERJ 55442 <br />~X~TZN~ TANK SIZE~ <br /> XZSTING DRAIN FIELD LINES= <br />SEPTIC TANK PUMPED) <br /> <br />AMOUNT <br /> $255,0~ <br /> <br /> $25~.0~ <br /> <br /> $~.~0 <br /> <br /> RECEIPT <br />TYPE: CHECK ~: <br /> <br /> ZTS IS,~ DATE. IF <br />MARION COUNTY BUILDING AND <br /> <br />REMARKS= <br /> <br />DONALD E. <br /> <br />OFFICE COPY <br /> <br /> <br />