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MARION COUNTY BUILDING INSPECTION <br />SENATOR 8LDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br /> 24 HOUR CODE-A-PRONE: 588-7904 <br /> <br />I am performing WOH~ O~ 8 D¢oOerty I own or occupy; <br />t am a registered builder OR the ~uthorized rep~,e~entetive <br /> <br />$ GNATURE OF APPt. ICA[~T: .......... <br /> <br />.......... ~,~d,,b.~,~._B,tI.~bL.'~ ..................................................... :.,.~ o3.~-2-~,~ 74 ........................................ ~P. EEZ.~E~.~ ~ ~L <br /> ~U~,~L.L,~ OR ~TZ2S . ~3.g~Z~_.]~.~. .................... J ........................... <br /> <br /> ~ ~ S~TE NU~ER= ~4-a3267 <br /> PHONE: 74~-!475 , VALUATION: <br />~ T ' <br />.......................................... ~ ~ ,~. ~o~, ~,, ....... ~ ..... <br />~,o'r~; ~ o~.~, &, j.u.8~ ~, .....; .............. ~, ......................... <br />~ J ........ ~ ......... .. ~, N ....... <br /> <br /> TYPE= ON-$~TE SEUA~E B~TER ~UPPLY: <br /> TEST HOLES <br /> PER~ZT OR APPLICATION HOc ~57~1 SZTE EVALUaTiON NUHBE~ <br /> CONTRACTOR~ NO~ ~ EXIST~W~ DRAI~I FIELD LiNEB~ 258 <br /> ~AI'TS~ BRIAN H .... =. "'.:" ~. '.:~ .' .;'. ~EPT'IO'T'ANK <br /> <br /> ~TE, ., "'". ~,, ' · ' '~'. ', '.. '"' ' ' . -~G~H{; .......... ~Y .... <br /> <br /> . ..:' "." .~ ..... ~ '." -.-".,TH~s :RECEIPT- .... <br /> ' : "?". '""" ".:.' '"".'.'..:.....~L~N~E DUE · ..... <br /> . .. · ~... ' .......... :".,,....:.'....': ..... <br /> p~ ~.. : ~ - ... .... · .. .. ...... .. ....... . <br /> .,~YL~. ~ATTo, ~RiAN H .'.. · 1' · . ..... <br /> <br /> s~;~: mT~CNE~ ~OCU~T ~OR' '~'~[~'~S.,'m..O~.-S~.~E~E~.Er~[~'; ........................................... <br /> <br /> " .', . ".'..i.;'.':'.:~_'.'.. ......... '; .' .... '."'. <br /> <br /> PLAH R~V;[EW~ BY "D~!['"' ' :" '"" CtTY:'JUR"!SD[CTIO~: BY .....~ .......... BATE <br /> <br /> <br />