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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OR-EGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 P,M. - 8:00 A.M. <br /> <br />Other_ <br /> <br /> I have read and agree to the [~rms stated on the reverse Bide of <br /> <br />l,,:~ ':,'1: ,.; 7 ¢ ,2S/,_, 7 2':7,[: ' ;}. 2S: 4 % <br /> ',...i &~,'l%;E T T. GAF;'< <br /> <br />TAX LOT: CATEGORY: <br />' CONSTROCTION TYPE; OCCUPANCY: <br /> <br /> CONTRACT CITY: <br /> <br />,~A,-, ~ ,..)"~ .... LN, i :'~ <br /> <br />;OCCUPANT LOAD: <br /> <br /> NO 0F 8EOR00M5 <br /> <br />'ZONE: MAP: <br />iOORNER: <br /> <br />~Ai. AT ER SUPPLY: <br />T,'ZST HOLE'S REA3Yt <br />SITE EVAi2,:AT ~ ON <br />EXTS?iNG TANK S;ZE <br /> <br />SEPTIC TANK c>U~qPED~ YES <br />'~REV;OUS NO <br /> <br />,0 AL, <br />t,-'R~V. OuS REC~-; ,, ~- . .:~ <br />THiS <br /> <br />F3AL.a,NCE DUE $0, ]3 <br /> <br />,, ....... ~ ................. CA 1 ....... ~ f:: <br /> <br />iii!: ~,":',n.,:.':,...d:~ L)OC)UHENi FOR REOLJIRE~E~]'S OF ON-S]'T~ SEWAGE ~YSTS~~. <br />'*: '7F, iS IS NOT A PE~ZT. THIS A~PLI~Ti~ ~Sl ~ T~'~~ i REVIEW P~ ~E,RE THE <br />FOLLOWING ~ST BE ~PLETEC. IT iS ~E R~S~SiBILi~ OF %dE APPLICANT TO AS~ ~%A'~' <br />ALL NECESSARY iN~O~ATI~ H~ 8E~ P~VIOED. <br /> <br />C:iT''/ ,JURiSD,,CTiON: <br /> <br />¢o,~ ~ ~; ~e *~v ~7 OFFICE COPY <br /> <br /> <br />