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MARION COUNTY BUILDING INSPECTION <br />SENATOR E~LDG. 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: 588-7904 <br /> <br />SA,~E <br /> <br />F'i-I Oi',] E:: 769-..-7'7 [;¢4 <br /> <br />TOWNSHIP; RANGE; I ZONE. ; MAP, <br /> <br />9046~92 <br /> <br />i4r'4'TE R SUF'PLY <br />TEST ]-]Oi...ES <br />SITE EVALUATION NUM~ER; <br />EXIST!N(; TANK SIZE: <br />EXIST:EN~ DR/4i N <br />SE[':'I']:C TANK F'UHF'ED~ <br /> <br /> At. ITHOR:i:?!AT]:ON NOT]:CE ..- Fl..Y), VIST'T <br /> <br /> TOTAL A,~,~L.,~,~[.~ I":'EE:S <br /> <br /> ,, At.., ;, C~,,, <br /> <br /> PAYEE>, RECEIP'f' <br /> RECI~:IVED BY:; NB ......................................................................................................... TYPE: <br /> <br /> SEE AT'['ACHE;l) Df]CUKENT FOR ]:~EQU:!:REHEIqTS OF' ON'"'SITCE SEWAGE <br /> <br /> · T~iS ~S NOT A PERmiT. TH~B APPLiCATiON ~U~T 60 THROU6~ A REVIE~ PROCESS ~HE~[ T~E <br />FOLL. E1WJ[F~G MUST BE] CD~PL~FJ'TED,, IT IS THEi RESP(]I',]SIB]:L]:TY SF' 'TI,,P:~. APF'i._]:C4FFf' TO ASSUi:~'E: 'f'HAT <br />~L.l... {,tE:CE:f:;SA~-;rY ]:!,.fF'3RMATZE~N HAS ]Z~EEN F'ROVIDE~),, <br /> <br />CIT"./ ,,,[URISb;(fZYf':~:ON: 3Y ...................... I)A'/'I::: .................... <br /> <br />~u ~ t,¢ ~-,~ ~v. ¢ OF FICE COPY <br /> <br /> <br />