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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 8:00- 4:30 <br />24 HOUR CODE-A-PHONE: 588-?904 <br /> <br />Other <br /> <br /> !, CONTRACT CITY: ! UGB'. i OCCUPANT LO I;). <br /> Cd.,, ,,,,k ...,... L.E <br /> <br /> SA~E: <br /> : SITE Ng~BER: 93-e1265 <br /> ~ hOtk... 767-~-'TTg4 ~ VAi.,UAT];ON~ <br /> <br />TYPE: ON-S%TE SEWAGE <br /> <br />PERMIT OR APPLICATION <br /> <br />[;ONTRAC'rOR,, <br /> <br />PHON£~ 769-'7'734 <br /> <br />9846~92 <br /> <br />WATER ~UPPLY'.' <br />7t,,aF lOLL.,, ,',,_.A~Y, <br />S ;I:'I'E E'VAL. LJA'/7[ ON <br />E× i,~T ]:NI~: TANK <br />E:X ?. 9'I'ZN(; <br /> <br />PREVIOUS NO. <br /> <br /> TOTAL ASSiF. SSEI) FEES <br /> PREVIOUS RECE'.~PTS <br /> <br /> ~AL.A~qCE DUE <br /> <br /> S~::E A'I"TACH~JJ) I)OCU~ENT i:r~R R~[.I:[REHEN'TS Oir OIq"-~]:TE SEWA~ <br /> <br /> A THIS ~S NOT A PER~IT. TH~S APF'LI~ATION HUS~GO THROUGH A REV~E~.PROCESS ~ERC THE <br />F:OLL'H'[;N[; ~flJST BE CO~PLE;T~;D,, ZT ISTHE I~ESPONb.,.91i,,,;[TY OF' THE APPL];CAF~T 'i'O ASS(..~RJ:: 'i",h.4, T <br />ALL hiECESSARY '~'.NFOREATZCN HAS ~E~'-~ <br /> <br />FORM # MC 1 ~-5~ REV, 4/90 <br /> <br /> <br />