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MARION COUNTY BUILDING INSPECTION
<br />SENATOR BLDG. NO, 225
<br />220 HIGH STREET NE
<br /> SALEM, OREGON 97301
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<br /> PHONE; E88-5147 8:00 - 4:30
<br />24 HOUR CODE-A-PHONE; 588-7904
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<br />SIGNATURE OF APPLICANT: ..................
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<br /> D,&TE: ....................
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<br />}Ow,e~, - ; RES.TDENTIAL
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<br />.....................................................i CONSTRUCTION
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<br /> ~ARZON COUNTY ~0
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<br />~ SUBDIVISION:
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<br /> SITE NUMBER:
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<br />PHONE: 749,.,2079 ! VALUATION:
<br /> ~ . ._ ~4 ;~_%~$ ..... ~ ................................. ~- . ·
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<br />TYPE: ON-SITE SEWAGE
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<br />PERHIT OR APPLICATION NO:
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<br />CON'fRACJ?R~ NO.
<br />BAK k;;R,, CNARL.ES
<br />SA~E '' :'""' ...... ; ....
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<br />f:'HONE~
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<br /> WATER SUPPLY: PW
<br /> 'rEST HOLES READY= YES
<br />SITE EVALUATION NUMBER=
<br />r.X.~STI~ TANK SIZe.
<br />EXI~T]:,~, ~RAIt~ FIELD LINES:
<br />SEPTIC TANK PuHPE9:
<br />'PRE~OU$ NO. ~E~ROOMS=
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<br /> ..............................]:TEN ~ .....TT":' ' "* "?-,, ¢~', % ........ "': ................ ?'-': -' ..................................... [1UANTITY AMO,UNT
<br /> AL-FEFtATION :" .......... "" ' ' ' ' ' 1 ".~'~
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<br /> · . .... I .. ...'. .. TOTAD.A~SESSED F.~ea $,255. g~
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<br /> /;,,,,?",5',,....".:,..'...;',!-..,:'.,-.,7~IS':REC, E'IPT:'"" ".': .. $255=0~
<br /> :Y";:/."?....:. :5;::...~:'.'i:::iiF~,'C.:d4i-~'-."i~u~ ':' ..i,. .. ~,., ~,,.-~,
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<br /> ~HA~LES ...'.,': :'...,;"; ,,., ,,, .. . RESEIF'T NO: ~f,~481
<br /> RL[;F_.[V£D BY.' j=. .............,i~.k:..~l;~,~_s(~,C..,=~.~.Z~.;.~.~,~:= ..:... :.. TYPE:: CK OH'EC,~ ~: 1115
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<br /> THIS IS NOT A PERM%Ts :T~IS,..'~PPL.[CAT-IOI~.':.'~ST "GO '~HROUGH A REVIEW PROCESS ~HERE THE
<br />FOLLOW~H~ HI.~ST ~IS ~P~[~;D,.'-',V[¢,J.~."~.~E' ':RESPOHSZ'~L-~TY 0F THE ~PPL 2CR~T T0 ASSURE THAT
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<br /> ~2EM¢:RKt"h: AI.TEf~ATiON~ T[i; ..READY,..
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<br />OFFICE COPY
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