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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: 588-7904 <br /> <br />I~r~ ~aer~el~tieStree, rdebd~ibl~iledr,r OR the authorized represen a ye S GNATMRE OF APP[. CANT <br />I am performing work on a property I own or occupy. <br /> <br />this document. <br /> <br />°w~'rE; 0~./26/91 T tl'4E: <br /> <br />iSlTUS ADORESIBRYANT, RONALD N. <br /> <br />10.02:18 <br /> <br />TAx LOT: '.CATEGORY: <br />CONSTRUCTION TYPS; i OCCUPANCY: <br /> <br />RESIDENT ].AL <br /> <br /> 14812 BO~'s AVE ---- <br />~J~N~'. Or4 9 ~;~00'2 ........................ <br /> <br />SANE <br /> <br />PHCN 678"~1065 <br /> <br />WIDTH: DEPTH: <br /> <br />:AREA: ;gNIT~: : IRREG. LOT; i CORNER: <br /> <br />'rYPE: o~-si'rE SE~tAGE <br /> <br />PEPJvlYf' OR APPLiCA'FfON NO: <br /> <br />CONTRACTOR, NO. <br />BRYANT, RONALO N. <br /> <br />PHONE.' 678-1065 <br /> <br />9031 ?83 <br /> <br />WRATER ~SUPPLY: CN <br />TF-.;SI' HOLES READY'. <br />SiTE E~/ALUAI'iON NUIV~ER; <br />~ISI'ING ')'~K SIZE: <br />~iSTiN8 O~iN FiELO LiN~: <br />SEPTIC I'~K PUMPED~ <br />PR~VI~5 NO. BED~: <br /> <br /> ti'BM <br />EXISTING ~YSTEN EVAL. RPT. <br /> <br />QUANTITY AMOUNT <br /> <br />$~00_00 <br /> <br /> TOTAL. AS,.S~ED.:FEEs $10 o. 0 o <br /> PREVi CtJS RECEIPTS $0.00 <br /> :: TH:iS RECEi PI' $10 O- 00 <br /> <br /> BALANCE OUE $0. O0 <br /> PAYEE: BRYANT, RONALO ~. , ...... , ,JN~i~..NO~' ~557 <br /> <br />* THIS i~ NOT A ~IT+ THIS,'ACPLI'~TI~ ~ST ~ TH~ A R~i~ P~ ~R6 THE <br />~LL~IN6 ~T BE ~PLETED. ITi8 ~E E~IBILiTY OF THE APPLI~T TO ~RE THAT <br />~L NEC~ ZN~T~ H~ BE~ <br /> <br /> ......... .... O,T, .............................. ..','. ................................. <br /> <br /> RE~R~; LO~ RE~R'T' ~5145 <br /> <br />FORM # MC 15.5~ REV, 4/~0 OFFICE COPY <br /> <br /> <br />