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(2'<4 <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> SENATOFI 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: 588-7904 <br /> <br />I a.m ge¢fofmklg work on a property I own or occupy, <br />l am a registered builder OR ( ) the authorized representative SIGNATURE OF <br />of a registered builder, <br />The work will be performed by a registered builder. <br />Other_ <br />I have read and a9roe to the term8 stated on the reYerse side of DATE: <br />this document, <br /> <br />L.. 0 N,r;; ,~ <br /> <br />'!' ZHE; -]J4:.26: <br /> <br />J,:t, 364 ,,JAHE,~ WAY SE <br /> <br /> ................... 0~ ' ! 66GL~P,~NT LO,~O: <br /> CONTRACT CITY ~ <br /> H~I:;:]:ON COUNTY 'El ,~ <br />........... ~ NO. OF 8EOROOM$ <br /> <br /> ;l:148;!. STEINKAHP ROAD SE <br />,, AUM['WILLE 9732,'!; SITE NUNBER: 9;~-~1906 <br /> 749-I,~.5 VALIJATION: <br /> <br />.......... J , ~ 1.6~ AC N9 <br /> <br />TYPE: ON-SiTE SEWAGE <br /> <br />PERmiT OR APPLICATION NO: 984747§ <br /> <br />CONTRACTOR., Iq[},, <br />I,,,ONG,~ WIL. L]:AH <br /> <br />AUMSV II.,,L,E 97325 <br /> <br />WATER SUPPLY: PW <br />S,T. TE EW . ,~ ...... ~ <br />EXISTING ~ 4 ~ _ . ~ <br />FREVIOUS ~ ~ <br /> <br /> SEE AT'FACHEI) DOCONIENT FOR REQUIREMENTS OF ON-SITE SEWAGE SYS'T'E;N., <br /> <br /> ~ THIS IS NOT A PER~IT. TH~$ APpLiCATION NUS~ 6O THrOUgH gA REVIEW.PROCESS WHERE THE <br />FOLLOW;[t,16 ~tJST ~{IE CO~PL. ETED. IT IS THE RESPONS]:~4];L];Ty OF ':HE APF'LILAI,Ft" f'O ASSU'r:d~; THAT <br />ALL NLLE, SSARY ]],]F'ORHATION HAS [~EEN PRO <br /> <br />~o.~ ~ uc ~s-~ n~v, 4~o OF FICE COPY' <br /> <br /> <br />