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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />220 HIGH STREET NE <br /> SALEM, QREGON 97301 <br /> <br /> PHONE 588-5147 <br />CODE-A-PHONE 4:30 P,M, - 8:00 A.M. <br /> <br />I ~m performing work on 8 Droperty I own or occupy. <br />~amaregistered builder OR( )theauthoN~ed representative <br />of a registered builder. <br />The work will be performed by a registered builder. <br />Othor <br /> <br /> I have read and agree to the terms stated on the reverse side <br /> this doeun~er~t, <br /> <br /> DATE: 03/29,/88 TIME: 1:01:15p <br />OWNER; <br /> BOCK, HENRY <br />SllUS ADDRESS: <br /> <br />TAX LOT: <br /> <br />CONSTRUCTION TYP~: <br /> <br />RESIDENTIAL.. <br /> <br /> 110~ ST <br /> DETROIT <br /> <br />USE OF B01L. DING; <br /> <br />MA~LtNG ADDRESS: <br /> <br />630 ELECTRIC ST <br />SALEM 97302 <br />PHONE; 585-1713 <br /> <br />LOT: ' BLOCK: <br />13 <br /> <br />OR 9734.2 <br /> <br /> HAMMOND <br /> <br />15 <br /> <br /> SITE NUMBER: 4009 <br /> VALUATION: <br /> <br />AREA; i UNITS; IRREO, LOT: CORNER: <br /> <br />MAP: <br /> <br />TYPE: ON-SITE SENAGE <br /> <br />PEI:~4IT OR APPLICATION NO; <br /> <br />CONTRACTOR, NO. <br /> <br />9007534 <br /> <br />WATER SUPPLYt CW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br />EXISTING TANK SIZE: <br /> FING DRAIN FIELD LINBS: <br /> <br />8OCK, HENRY ,~~ [C TANK PUMPED; NEVER <br />630 ELECTRIC ST [OUS NO. BEDROOr4S: 1 <br />SALEM 9?309 <br /> <br /> ~/ ~CEIPT $100~00 <br /> ' SAUCE ~E : $0.00 <br /> <br />PAYEE 8~K H~RY ~N~OICE NO 8169 <br />RECEIVED BY; DN .... ~FE~': I~.':..CHECK ~: 0 <br /> <br />FO~]NG ~8T BE ~PL~ED. IT ~S ~E R~:~B~IL[:~ OF ~E APPL[~T TO ~RE ~T <br />ALL NEC~ [NFO~T]~ <br /> <br />PLAN REVlEIN: 8Y~Jj~_b__~ DATE <br />RElv~ARKS +* ALTERATION <br /> <br />CITY JURISDICTION: BY ........ <br /> <br />DATE .......... <br /> <br />OFFICE COPY <br /> <br /> <br />