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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 .~88-$147 <br />CODE-A-PHONE 4:30 P.M. - 8:00 A.M. <br /> <br /> I am performing WOrK on aproperty I own or occupy, <br /> I am a re§istered builder OR the authorized represen <br /> of a registered builder, <br /> The werk will be periormed by a registered builder. <br /> Other <br /> I have read and agree to the terms s~ated on the reverse side of <br /> <br />DATE: 02/"8/88 <br /> <br /> ,.,U L,AY, ADRIAN <br /> <br />USE OF BblLDING: <br /> <br />MAILING ADDRESS: <br /> <br />LOT: <br /> <br /> , TAX <br /> <br />OR 9?325 <br /> 5,,0 <br /> <br />SUBDIVISION; <br /> <br />~EE; :2, EN T :.41 <br /> <br />OCCUPANT LOAD; <br /> <br />iNO 0F BEBR00M$ <br /> <br />VALUAT I ON: <br /> <br /> ~L' <br /> <br />PERMIT OR APAL, ZCATiON NC: 6788 <br /> <br />CONTR.aCTOR ~ <br />LULAY. ADRIAN <br />:;~981 SHAFF RD SE <br />AU'~.iS',/~ i,H, E! OR 9?325 <br /> <br /> WATER SUPPLY; PW <br /> TEST HOLES READY* <br />SZTE EVALUATZCN NUMBER; <br />'EX;STZNG TANK S;ZE; <br /> <br /> SEPTZC 'TANK PUMPED: <br /> PREVZOUS NC. BEDROOMS: <br /> <br /> 1' '" EM OU AN T' .,'. TN AMQLIN T <br /> TOT,A,L ~SESSED ~EE:S $ 3 t. C ( <br /> <br /> BALANCE DUE -' <br /> <br />PAYE~: LULAY, A3R~A% RECE;P~ NO: .-'~ <br />~_.(..E.VL,¢ BY;,.L .................................... ~PE~ CA ?HECK ~: <br />SEE ATTACHE) 9OCU~E~T FCR ~EOU; RE~ENTS OF ~-S;TE,SENAG~,SYSTE~. <br /> <br />~ THiS ;S A VALZD PE~ZT ~ TRZS PE~ZT ~,ZR~ ~80'~ ~F~ ZTS ~E CATE. ZF <br />~T~CTZ~ FA2LS TO RE~ ALL, RE~R~TS:,OF S~ATE ~ ~B ~RZ~ ~N~ BU2LD;NG ~%D <br /> <br />c4EIYfARKS; REPA; R <br /> <br />.... /~ .... ~,;. ~', O,,~L__Y, ~4A.R;CN COUNTY b3'...,~LOZNG OEFTCTAL / ~¥ ................................... ~ <br /> <br />,o~u ~ Mc ~.~ ~uv.~/~¢ OFFICE COPY <br /> <br /> <br />