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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG, NO, <br /> 220 HiGH STREET NE <br /> SALEM, OREGON g7301 <br /> <br /> PHONE: ~8-S147 g:~ * 4:30 <br /> 24 HOUR CODE-A-PHONE: 5~-7904 <br /> <br /> a ~eg{~teted builder OR [ ) the authorized ~epresentafive S(GNATURE OF APPLICANT~ <br /> <br /> ' ~ESI~ENTI~L <br />KEU~LL~ L~EEY ................. -.-. <br /> <br /> ~U~SVILLE O~ 97325 ~[OH COUNTY <br /> <br /> 1575 C~RID~E DR SE <br /> SALE~ OR 97382 ~ SITE ~H~: <br /> PNONE= 588-5724 ~ VALUATION: <br /> <br />TYPE-' ON-SITE SEll:GE <br /> <br />PF_~HIT OR APPLICATION HOt <br />CONTRACTOR. NO. ~&786 <br />vALLEY SEPTIC <br />P 0 ~gX 5241 ',' <br /> <br />F'HONE= 588-1115 <br /> <br />9e58877 <br /> <br /> NATEE'S~PPLY: P~ <br /> TEST HOLES READY: <br /> SITE EVALUATION NUN~ER: 54487 <br /> EXISTING TANK SIZE: <br /> £XISTIN~ DRAIN FIEL~ LINES: <br /> <br />"' PREV~OU~ NO, BEDROOHS) <br /> <br /> IT£" ' ~0,...~":"'" "'" ~UA"TITY ANOUNT <br /> sTANDARD ONmSITE ~TSTE~' <br /> <br /> RECEIVE~ BY: ~ ........ ~_"~'_:~:'~'~'_~L='~"~_~"~_":-'~'~.-=,~ TYPE: CK OHEC~ ~: [945 <br /> SEE ATTACHED DOCUMENT ~OR,._ /---- ----REQUI~H~NT~' ..OF,,O~$I.TE SEWAGE SYSTEM. <br />* THIS IS NOT g P~IT;' :'THIG~'~EZC~TiOH: ,~' ~' T~H a REVZEU PROngS ~H~E TH <br />FOLLDWZHG MUST BE COMPLETED;'...'.:IT',;IS.-IHE";.'~RESPON$IBI~TY OF. THE APPLICANT TO ASSURE THaT <br /> ,: "':..'../:::,':", ~r".'. . ... 4', ': .',: ": ~. ' · <br /> <br />OFFICE COPY <br /> <br /> <br />