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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 /> CODE-A-PHONE 4:30 RM. - 8:00 A,M, )
<br />
<br />{'~ I am performing work Cna roperty I own or o¢oupy, '_/.~..~.~.. ~ ¢ ~t%~.~,k.%,~
<br /> I am a registered builder On ( } the ~luthorized representative SIGNATURE O¢ APPLJCAN
<br />
<br /> Other q
<br /> The wOrk wjll be performed by a regiStOred builder' DATE q-I\-Pa', cia
<br /> I have read and agree to the terms stated on the reverse side Of ' -- /
<br /> MOOD. NAYNE L. c.,ESiC£NT[A~
<br />
<br /> 7918 ST'ONEFZELL) CT SE
<br />,~L..L'¢tSV i[L L ~E OR 97325
<br />
<br />CONTRACT CITY: UGLY; OCCUPANT LOAO:
<br />~4A~ ION COUNTY NO
<br /> NO OF BEDROOM,~:
<br />
<br />MAILING ADDRESS;
<br />
<br /> SA~E
<br />
<br /> PI"~ON E: ?49-2236
<br />
<br />LOT: BLOCK:
<br />
<br /> 3
<br />wIDtH: DEPTH:
<br />
<br />STONE¢1' ELD GLEN
<br />
<br /> SITE NUMBER; ?828
<br /> VALUATION:
<br />
<br /> 28 8S 2M AR 5'~
<br />5.39000 AC YES NO
<br />
<br />"""PS: ON"'S.TTE SEWAGE
<br />
<br />PER'"/ZT (:;[~ /,.,PPLICATZON NO;
<br />
<br />CON TR.aCTOR. NO
<br />'~vQO0, MAYNE L
<br />
<br />PHONE: 74.9-2288
<br />
<br />90~8795
<br />
<br /> I 'TEM ~.MOt.!N ?
<br />PRESSLIRE D E STR ;'SLIT ~ ON .$18~., =,..~'
<br />
<br />MATER SUPPLY: PM
<br />TEST HOLES REAOYt
<br />S~TE EVALUATION NURSER: '!7423
<br />EXISTING TANK SIZE:
<br /> DRAIN: F~ELD LINES:
<br />SEPTIC TANK
<br />F/R~V;OLJS NO_ BEDROOMS:
<br />
<br /> ¢0 ?,::?
<br />$':55 Cc
<br />
<br /> =,
<br />
<br />k/;i.Y..~.~.~_~OOD, ~YNE ,_ ,, :i,,,,,,,,:;, ::: :,:,:, t,,:, :,,', ,', ,,, ~,I~ECEIPT NO 19935
<br />
<br /> DOCL MENT FOR
<br />
<br />* TH~S ZS NOT A PE~ZT. P~E~ ~ERE
<br />(OkL~G ~¢T BE =~E,:; :EES~SIBIU~ ,OF,:;~E =APPLIO~T TO ~RE THAT
<br />A~L NmU~AR INFO~TION
<br />
<br />:.:;E~4AR~S; PRESS r}:[ST R:~7778
<br />
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