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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br /> Pc, O HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8;00- 4:30 <br />24 HOUR CODE-A-PHONE:'588-7904 <br /> <br />SIGNATURE OF APPLICANT ............ <br /> <br /> ~C~UPANT LOAD: <br /> <br /> AURORA OR 97~B2 ,,AURORA <br /> <br /> 26~t STAFFORD <br /> <br /> V~LU~TZON= <br /> <br />-" . ~ ................ !-~ ......... ~ .... ~,,,,~,~ ........... !,.-~.~ .................... :~... ~* ............. <br /> 16[t [ __ 'L~ ............ [____$E ............... Y,Eo ........................... NO .................... <br /> <br />WATER SUPPLY: CW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: KASEL PM2 <br />EXISTING TANK SIZE: <br />EXISTIH~ BRAIN FIEL~ LIMES: <br />8F-..,PTIC. TANK PUMP£D: <br />PR£V~OUS NO. <br /> <br /> ITEM ~JANTITY AMGL]lJ'I' <br /> STAIqDARD ON-S'rTE SYSTEM J 1 <br /> :' '~ .... TOTAL. ASSESSED. FEES $255~ <br /> '".~ ~ ....... PREV[GUS RECEIP.TS $~,, <br /> <br /> *.THis IS A ~ALI~ PERMIT. ~L' '~'RIS"P~I,¥,EXPIRES ~6~ ~AYS FR0~ IT~ ISSUE 9ATE, IF <br />C0F,~STRUC'F~'0N FAI~S 'f~ MEET.: 'A~L",~EQUI'RENENTS OF STATE OA~B' AN~ MA~IoN Cf l NTY Bt ~:_DI,G AND <br />ZOHIN(; ORal ~AI,iCE~,, T; IS PE~Ht~ SH~Eb.: BECOME NULL'AND. <br /> <br />!~[ihhqi. t~ 1L. <br /> <br />BUlL.DING OFFICIAL / BY <br /> <br />FORM I~ MC 16-56 REV, 4/~.) OFFICE COPY <br /> <br /> <br />