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MARION COUNTY BUILDING INSPECTION
<br />SENAI'QR BLDG. NO. 225
<br />220 HIGH STREET NE
<br /> SALEM, OREGON 97301
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<br /> PHONE: 588-514,7 8:00 - 4:30
<br />24 HOUR CODE-A-PHONE: 588-7904
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<br />I am performing work on a property I own or occupy.
<br />l am a registered builder OR ( ) the authorized representative
<br />of a registered builder.
<br />The work will be performed by a registered builder,
<br />Other
<br />I have read and agree to the terms stated on the reverse side of
<br />lhis document.
<br />
<br />L,I'ML;D,,
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<br />TAX LOT
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<br />CONSTRUCTION TYPE
<br />
<br /> I 2.6, LEVE:;'HAN
<br /> ¢~1 rbl S V ;t: l..I._!ii; n~
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<br />MAILING ADOR~S~: ..............
<br />
<br /> OE 6d'~'T~%~T-~I:r-'~; ....... ]~'B: .... ~EOU'~N¥ 'LOA6. ' c~'
<br />97S2'5 HARIF1N COUNT~ k:n [
<br />
<br /> SUBDIVISION
<br />
<br />.... ~,.~0 HARKET , NE
<br />E AI,,EH CR 977;0;i
<br />F'.'HOi,il,,_".' ::(62 '"4f~)73
<br />
<br />~IbTH. iDEPTH: AR~'
<br />
<br />-rYF;E: ON-SITE SEWAGE
<br />PERMIT OR APPLICATION NO:
<br />
<br />LOIITRACYL,~, I h.),,
<br />} '[l,l(;-(:J, 'i"l~'O'
<br />
<br />SAL, EH :1~,4'- "~-'97,~B,f,'
<br />PHONE:: 342--4~73
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<br /> ~A'I'.F_'I~ SUPP Y {~
<br />"' ?:,,~l Ht,ILES READY:: yes
<br /> SI'YE EVA L A-~'ZOt,} I,iU~'[.'iI~:R~ S:M,K)F~ EST
<br /> EXISTINg; i"ANK SIZE:
<br /> EXIS'F:!:N(; DRA:i:N FtEL. D L];NES:,,
<br /> SEPTIC TANK t::'U¢IPED:
<br /> Pi:;~E;V;[0LJ~ hi0. BEbR00HS:
<br />
<br /> S'FAI'.IbflRD O'--S];'f'E S¥S'?Et'~ /_l fAN'T:[TY z-h(.,..,,"
<br /> ].
<br /> TO'rAL A ~E. ~,~ED t-El:o ~,'
<br />
<br /> }:¢A[_A!~SE DUE
<br /> AI(,,L,, L.:[N(;O,¢ TED - ....... r",--
<br /> RECEIVE'D BY;; c! kL, k L- ho,, 48596
<br /> TYPE:: CK C-
<br /> ~,~::..~TIALIff,,D DO[,IJMI=I,tf FOl.4 RE[~U,[REMEI',tl'S OF OI4-,,SlTE SE'WAI;E SYS'I"F'H.
<br /> THIS IS A,,,VALID. ~- PERMIT._.,, * THIS PERMIT EXPIRES ~6~ DAYS FRO~ ITS ISSUE DATE. IF
<br />CONSTRUC'Y'];Oh; FA.d.,,,:~ TO ~,~::.Y AL, L REDUZREMEH?S OF STATE LAWS AN~ NAR:i;ON ' '"'
<br /> ........ . T~'I,,~ ::'E~H]'T SHeLL ~{ECOHE NULL ~ND
<br />
<br />:;,'~HA'aK!rql SE: {,,I ~, T0 S'['D SYSTr_-'.'~
<br />I)ONAI_I) E,, ~O0:DL. EY,¢ HAR:I:OI,i COUhF/"Y I;fll]:i,,l)ll,i[; OF':'F'"'r ..... r"A,,, / '¢I~"
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<br />FORM ~ MO 15-58 REV. 4/90 OF FICE COPY
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