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MARION COUNTY BUILDING INSPECTION <br /> SENATOR SLOG. 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: 58847904 ', ' <br /> <br />I am performin9 work on a property I own or occupy, " <br />I am a registered buirder OR the authorized representative SIGNATURE OF APPLICANT: <br />of a registered builder, ' <br />The work witl be performed by a registered builder, - <br />Other. ' · , , , , · <br />I have read arid asree ~o the terms stated on the reverse side of OATE: ~_~. ....................................................................... <br /> <br />?49-2668 I SiTE NU~ER: 13763 <br /> <br />165i 234, <br /> <br />'fYPE: ON-SI'rE SEWAGE <br /> <br />PERMIT OR APPLICATION NO: <br /> <br />CONIRAC'I'OR, NO, <br />'T'HERRIEN. HARRY <br />SAME <br /> <br />PHONE: 749-2656 <br /> <br />WATER ~SIJPPLY: PiN <br />'T'E~T HOLES READY: <br />SiTE ~WALUA'fiON NUMBER: <br />EXiSTiNG TANK SIZE: <br />E,~ISTiNG D~IN FIELD LINES: <br />SEPt: 16'..:$~K.. ~RED: <br />PRE~I~S NO. BED~t <br /> <br />REPAIR - f~AJOR , :. <br /> <br />(,~AN'I'i'I'Y ANOUN'I' <br /> $8o.oo <br /> <br />$80,00 <br /> $o,oo <br /> <br />$0.00 <br /> <br /> PAYgE: :': ':. ,,. !;:RECEiP'¥ NO <br /> RECEIVED BY: O~ ' , CHECK <br /> SEE A'fTACHED LY.X:.IJMENT FOR R~QU.I:REIVlp_3'4q <br /> ~ THIS IS A VALID PE~iT * <br />, ~T~CTi~ EAI~ TO <br /> Z~ING OROiN~C~, THIS <br /> <br /> iTS 15,SUE DATE. iF <br />MARION (llJNTY BUILDiN6 AND <br /> <br />R~RK~: MAJOR REPAIR R~6731 I,~'~ <br />gX.i)NAL9 E. WOODLEY. ¢4ARiON COUN'I¥ BUiLDING OFEiCiAL / BY <br /> <br /> <br />