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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HiGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-51'~7 ' 8:00 - 4:30 <br /> 24 HOUR CODE-A-PHONE: 588-7904 <br /> <br /> ~rh performing work on a DropeperJ~t ow~ or occupy. . <br />I am a reglsfered b~tllrJet OR (l~Yl[he au~hori=ed reptesentabve <br /> <br />~IGNATURE OF APPLICANT: <br /> <br /> TAX LOT: <br /> <br /> F'J'"I'TIN~,~ ,.,I~HEB ,',. ~.ON]Cg , <br /> <br /> _,L , .............. J .................................. <br /> <br /> PHONE: 74~'-[~ <br /> <br />U J l ..... ' '[.5 I ~,, [HO L.NO ................... , ..... <br /> TYP~: BN-~TE <br /> <br /> gON~RACTD~ NO. 4579~ · · , EX~TING DR~IN F~ELD LINES: <br /> VICTOR~=5 STAYTOIIF~N~ ~[LSONsciO ~R B, ~ '~'~-~'--'~'~:~-~'?':-'~'~"~US~'NG:""'~E~DOHS=?~ ~ '~' ~R~ <br /> PHONE: <br /> <br /> ~ TE~ ~ '~ '{''" <br /> GUANT]TY <br /> AMOUNT <br /> STANDARD OH-SITE SYSTE~ <br /> .. <br /> <br /> P~YEE: VICTOR FR~NK:~I~ · RECEIPTO: 6~7B <br /> RECEIVE9 SY: H~ :.~TYPE: CK NCHECK ~: 3~,t3 <br /> SEE AT'rACNED ~OCUMENT ~STEH, <br /> · ~IS IS NOT A PE~IT. REVIE~ PROCESS WHERE THE <br /> F~LL~JIH~ NUST DE ~[E~.T~ THE RPPLICANT TO ~SSUt~E TH:~T <br /> ~L..L NECESSARY ,e .~,< ~' :'.~'" '".': ..... ;.': ~'. <br /> ~i ._., .,~,.:., ... <br /> <br />'¥O~M ~' ~ ~*-.~ P.W. ~ OFFICE COPY <br /> <br /> <br />