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SENATOR BLDG. NO. 225 <br /> 220 HIGH STREET NE <br /> SALEM~ OREGON g7301 -'-~ <br /> <br /> PHONE: 588~5147 8:00- 4:30 <br /> ~ 24 HOUR COl)E-A-PHONE: 588-7904 <br /> <br />T~e w~r~'w},t be p*~ o~med by, r~istem~ builder, ' <br /> <br /> / <br /> <br /> AUHSVILLE OR ~25 '' MARION, Cou~ NO ' ' <br /> <br /> PHONE.- 749-1287 ,: ~ , V~LU~TIDH~ <br /> <br /> , I , ~ ~.~,,t ~ I ~ ............ ,'~ .............. <br /> <br /> ~: 0~8%~ ~ . . I ~ATER ~UPPLY: PW <br /> ' i TEST HOLE~ READY: NO <br /> ~T ~ ~Z~TZON ~0~ ~3~ { SZTE EVaLUaTION NUH~ER: <br /> : [ EXISTIN~ T~NK SIZE: <br /> CONTRACTOR. HO. · . : ' · : ~%STING DR~IH. F~ELD LINES: <br /> SflHE ,~ ~- ':, .... ,",'"'-'-"PREVI'OO~ NO;' ~E~ROOH~,. <br /> <br /> ~TEM ~ .... ~"' ~- .':~ ...... ~ ~UANTITY A~OUNT <br /> S~TE EVALUAT~ON~ ~,,, ~ ,265. ~~ <br /> <br /> P~YEE= HOWELL/Ill ~ ~ECE~F'T ND= <br /> EECE[VE~ ~Y~ C~.__g'. TYPE~ CK CHECK ~ <br /> SEE ATTACHE~, <br /> <br />ONSTRUCTION <br /> <br /> PARCEL. PLANNZNG ,AND <br /> NSTALLATION BEGINS. <br /> <br /> -. ..................... <br />, JU[~]:S/)ICT ION.. BY ...... ~ATE <br /> <br />rO~M # Mc ~-~ ~v, 4~o OFFICE COPY <br /> <br /> <br />