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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG. NO. 225 <br /> 220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br />~[ amain regiptereda r~?steredb~d~r,buiJder OR ( ) the authorized representative SIGNATURE OF APPLIO ~,vf <br /> <br />The work will be performed by a registered builder. <br />Other <br /> <br /> :[9687 C:ASF: RD <br />AURr)RA <br /> <br />LO'I: <br /> <br />; CONSTRU6TiON ~RE: <br /> <br />CATEGORY: <br /> <br />MAP; <br /> <br />3 <br /> <br />WIDTi h <br /> <br />DEPTH: <br /> <br /> ............. NO Nfl, <br /> <br />9 <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />S,~"E EYALUA'FION NLIMB¢.'R: <br />EX:[S'T:[Iql; 'I'AI,IK S~ZE: :1.7~ <br />FX~STIN(; DRA)'N I:"~;EI,,.~ I_INES~ <br />SEPT:lC TANK PI.JHPEb~ L,.,.28-93 <br />F'RFVIOU9 NO. BI~:llROOHS: 2 <br /> <br />AU'IHCiI:),];ZAT]:ON NOT'CF - FL, I). VI;S,I:'f <br /> <br />RI.:'CI~;fVIT]D 14Y:: PH <br /> <br />TOTAl._ ASoESSE.I) FEE,,, <br />PRFVIOUS RE, I.,EII TS <br />'1 ;-I], S <br /> <br />QIJANT];TY Ai'iOUNT <br /> <br />$ ]. 6¢2L, 00 <br />$ ]. 6tr),, 00 <br /> <br />BAI ANCE liLlE <br /> <br />RF:I;E]:PT t,ll:): 47916 <br /> <br />iYI I..,, Gl( LHELk :I~: 5:146 <br /> <br /> SF(: AT'lA[triED I)OCl.l~Fl,!'f' FOR REQU]:REFIENTS OF 0N-.iS]ZTE SI::WA6E !~YSIII~]~. <br /> <br /> * TH~S IS NOT A PERMIT. THIS APPLICATION HUST ~ THROUGH A REVIEW PROCESS WHERE THE <br />FOI,i,I.,I]Wi[NG MUST gE COI'IPI,.EI'E~. ~1' tS THE RESPONS'[B~LI'rY f.)F' THE AI:'~:'ki,((:AI,I'I' TO ASSURE Tl"lA~Ii' <br /> <br />RIFi'/ARI(SI; AIITI,,I [:I]-I:-I:O Vl,~,~] <br /> <br />C]:TY ,.ILlR'(!i{t) (i',¥t:qN~ BY .........................bATE ....................... ,¢ <br /> <br />OFFICE COPY <br /> <br /> <br />