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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. 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-PHONE: 5~-7904 <br /> <br />I am a registered builder OR ( ) the ,u~horized repre~e~t~flv~ SIGNATURE OF AF'PUC..ANT:.. <br /> <br />O~her <br /> <br /> 795S <br /> SPENCER <br /> LN <br /> <br /> ........ ....................................................... ~Ts~ ............................. <br /> i <br /> <br /> k ,,CK GOHF.,,~, <br /> ¢,23~ ? PAC1FL H~Y t4~BN ~7~71 ~TE ~ER: <br />: f: HONE~ 769-774~ J VALUAT!ON~ <br /> <br />~r~', ............... ~s~;: .......... {~ ~..~ ..... ~'c~,-- _j....~om.: '-~- ....... <br /> <br />.......... :,:,,: ................. ' ~._..,_ _ ,,, t" ~,~ ffl NO ~;;m ............ <br /> <br />TYPE: 0N-SITE E~-';WAGE WATER SUPPLY." PW <br /> TEST HOLE~ READY= YES <br />PERMIT ~ APPLI~;ATtON NO: ~11~1 SITE EVALUATION <br /> EXI~TtNG TANK SIZE: <br />CONTRACTOR,, NO. 34~16 EXISTING ~EAIN FIELD LtNE~: <br /> 9'~'AYTON SEPTIC .v, ,?.::. <br />41155 ~TAY'FOI,I ~CIO DR,,~'~" , PREVIOUS NO. BEDROOMS: <br />STAY~EIN~ 97~8~ <br />f HO~ } , 769 <br /> <br /> I'I'¢ff '": ~'' <br />SAH~ FIL.'rER <br /> <br /> ...... ,'~ flUANTITY AMOUNT <br /> :L <br /> <br /> rE:ES <br /> ,,,'",'. ,: $480. '" <br /> <br /> ',... ~' RECEIPT NO: 63826 <br /> ;: : TYPE~ CK CI-I~CK <br /> <br /> REVIEW PROCESS WHERE THE <br />[~7;~ ,, APPLICANT '1'() A,oSU,~[. Ti. iA'(' <br /> <br />OFFICE COPY <br /> <br /> <br />