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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 <br />POPE-A-PHONE 4;30 P.M. ~ 8:00 A.M, <br /> <br />I am performing work on a property I own Or <br />lam 8registeredbuliderOR( )theauIhorizedrepresentative <br /> <br /> SARNARD, <br /> JIM <br /> <br /> ?582 BISHOP RD SE <br />A_ F¢,¢'S/. ~.LE OR 97325 <br /> ~RION COUNTY { NO <br /> <br /> SANDY COULTER; REALTOR ............................................................................... <br /> 515 COMML NE SALE~ 97~01 ,~, <br /> PHONE: S64-9596 ..- ~ ,~l~i~ SITE NUMBER: 5G33 <br /> VALUATION: <br />LSF: [~OCK: ;SECTION: TOWNSHIP: :RANGE; ~ ~5~'~'; .................... <br /> <br /> TEST HOLES R~ADY: <br /> PE~IT OR APPLICATION NO: 9011546 SITE EVALUATION NO. ER= <br /> ~;STING TANK <br /> CONTRACTOR, NO. ~ EXISTING ¢~IN FIELD LINES: <br /> BARNARD, JI~ ~ $ER,IC TANK PUMPED: <br /> SANDY COULTER: REALTOR ~/ PREVIOUS NO. BEDROOm: <br /> 615 C~L NE S,ALE~ 9730! ~ <br /> PH~E: 364-9598 <br /> <br /> ~ TEM qUANT ~ TY <br /> EX~ST~NG SYSTE~ EVAL. ~PT_ 1 <br /> <br /> TOTAL A~SEB FE~ $100 <br /> PREVIOUS RECEIPTS $0.00 <br /> THIS RECEI P~ $100.D0 <br /> BALANCE DUE~, , <br /> PAZ~E: COULTER, SANDRA ~ ' ,:~ECE~PT NO: 12271 <br /> RECEIVED BY: XXX ......... ~ .... ~ ...... ~ ;'~PE: CK~,~ECK ~: 940 <br /> sES ATTACHED D~U~ENT FOR REQU';RE~EN~S OF <br /> ~ ~IS IS NOT A PE~IT. THIS APPLICATI~ ~ST ~ ~ A R~I~ P~ ~ERE ~E <br /> FOLL~ING ~ST BE ~PL~ED. 'IT I~ THE R~I~I~I~ OE~'APPLI~T TO ~RE <br /> ALL NE~RY INFO~TI~ HAS ~E~ ~VIDED. ~ <br /> <br /> OAT - Y ~URISDICTION: ~Y ~TE <br /> <br />PLAN REVIEW: 8Y___/'_~____ <br />REMARKS: LOAN R~5092 <br /> <br />OFFICE COPY <br /> <br /> <br />