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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 225 <br />220 HIGH STREET NE <br /> SALf~M OREGON 97301 <br /> <br /> PHONE 588-5147 <br /> CODE-A-PHONE 4:30 P.M. - 8:00 A.M. <br /> <br />Other <br /> <br />I havo road arid agree to the terms stated on the reverse side of <br />this document. <br /> <br />SIGNATURE OF APPklCANT: <br /> DATE: <br /> <br />OWNER: <br /> <br />SITUS ADDRESS: <br /> <br />TAX LOT; <br /> <br />CONSmDCT,or~ TY~,~: <br /> <br />CONTRACT CITY: UGB: <br /> <br />LOT <br /> <br /> SI. E <br /> VA ~,.J..... <br />BLOCK: 'SECTIONZ :~OWN~I-q P: RANGE; <br /> <br />DEPTH: AREA: U ~ITS; IRREG LOT: <br /> ~'" ~'~- a- NO <br /> <br />CATEGORY~ <br /> <br />OCCUPANT LOAO: <br /> <br />1949 <br /> <br />S; TE E"¢'ALUA T i CN <br />EXiSTiNG TANK SIZE: <br /> <br />P~,...?z JU,:, hLE~,'-'zr' ,S <br />TH l ?_, ' ...... - '- <br /> <br /> THiS IS A VALID PEF~,lZT ~ THiS PER:NIT ~XPIR~ 350, DAYS FRON ITS !~E DATE_ iF <br />,..~,_, &%CTI~ FAD~ TO MEET ALL R~IR~TS OF STATE ~ ~D ~RI~ C~DUN]'Y -' "' '-: "-' <br />ZQ~;NG ORDZNANCES, TH~S ~E~1T ~ALL BEdE NULL ~NO ~ZD. <br /> <br />REMARKS: SEPTIC REPAIR 87-586 R~272a,',, ,,: :!*,i', ': ::, ~ :: <br /> <br />~on~ ,, ~c ~:~.:,. .er ~7 OFFICE COPY <br /> <br /> <br />