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MARION COUNTY BUILDING INSPECTION
<br />SENATOR BLDG, NO, 225
<br />220 HIGH STREET N6
<br /> SAL~:M, OREGON 97301
<br />
<br /> PHONE: 588-5147 8:00 - 4:30
<br />24 HOUR CODE-A-PHONE: 588-7904
<br />
<br />I am a reQistered builder OR ) the authorized regresentative
<br />Other
<br />
<br />I have read and agree to the terms stated on the reverse side of
<br />this document,
<br />
<br />OWNEM:
<br /> HC!]!'_'iY, F~ON/!i. '0
<br />
<br /> 75 Z ('", ;'~- 140 P, E S '~ D E N T ]' A L.
<br />
<br />.................. ~b'6~
<br />
<br />SECTION TOWNSHIP
<br />
<br />SITE NUMBER:
<br />
<br />~VIDTH= CiVEt'TH. ........ AREA; .............. U'~ITS'. IRREG. LOT . CORNER'.
<br />' ,:t ¢'~r;; NO J
<br />
<br />TYPE: ON-SITE SEWA6E
<br />
<br />PERMIT OR APPLICATION NO:
<br />
<br />C/)Iq"I';;h~CTOR,,
<br />
<br />47794
<br />
<br />WA'f'ER SUF'F'LY
<br />TEeT HOLES
<br />S,TTE EVAL, UA'F:[C)N NUMBER:
<br />EX]iS'TING TANK SIZE',',
<br />EX]]ST:[N6 DRA;N Fl;ELD L.:i;NES~
<br />SEF"F]:C 'FAMK PUMF%D: ;~,,,,26,,,9J,
<br />PREV;EOUS NO.
<br />
<br /> ~}; TEit QUAIq'T I TY
<br /> ANNUAL L-",]VAi .... "r' ", ' ',p"
<br />
<br /> TOTAL ASSESSE~ FEES
<br /> PREV~;OUS R~''°°~;,~4:,~." ......... o
<br />
<br /> F'A Y~;E 4', '" ........... 'T
<br /> k, ,.,I.' ~'" r' -'-"'.v,"'D BY;', CE. ................................................................................................. 'FYF:'E ~ CHECK
<br />
<br /> * THIS iS A VALID PERMIT * THIS PERMIT EXPIRES ~6~ DAYS FROM ITS ISSUE DATE,
<br />..'~,~-'::,, .. ....... ,r' ~,,A.I. Lo Ig HEEl' ALL.. RE~2U~[R~[~ENt'S OP .~ATI: LAW~ AND MAFU:('.IN COUNTY
<br /> ~ .~,:,,~ ORD'.I~NANC:~S,,. ~'u"o,,.,,o PERD~?I' S-~A,,.L ~:~COH:::, N U_L. AND VOID.
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<br />NEXT REV]ZEW DUE 7/9/95.
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