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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: 588-7904 <br />I Sm performing work on e property I Own Or occupy , _~.~ _.~.~...~._.~_~.._~_. <br />I am ~ registered builder OR ( ) he author zed representa ye SIGNATURE (DF APPLICANT; <br />of S registered builder. <br />The work w be pedormed by a registered builder <br />Other ' <br />I have read and agree to the terms ststed on the reverse side of PATE; <br />this document. - <br /> <br /> AU~SV;~L[_E OR ~7~2~ ~ARION COUNT NO <br /> <br /> " <br /> <br /> ~73 WINTER ST NE <br /> SALEM OF( 77381 ~ITE NUNBE~: ~3-B23~1 <br /> PHONE: 371--~518 VALUATION: <br /> <br />TYPE: ON-SITE SEWAGE w~'rER SUPPLY: RW <br /> TEST HOLES READY: YES <br />PE~iT OE ~PPLICATION NO: ~48281 SITE EVALUATION NUMBER: <br /> EXIST];N6 TAWE SZZE. <br />CON'I'RAC~OR~ NO. 85813 EX];STING ~RAZN F'IEI..~ L[NES: <br />A & B Sep~:~c Service Inc ¢~ SEF'T]:6 TANK F'UHPED: <br />Salem ~7~8;~-.8888 ,' ~ <br /> <br /> ITE'M : , "'; , - ............ ~5-~ .............................. <br /> , QUANr J. 1 Y AMOUNT <br /> <br />RLPA,I,k - MAJOR <br /> <br /> PAYEE: A &B <br /> RF2CF'IVED BY: DM2 <br /> ....................... <br /> SEE ATTACNE~ DOCUMENT~F <br /> <br /> ~ THIS IS ~8T A <br />FOLLOWING HUST BE <br />ALL NECESSARY ZNFOR~AT <br /> <br />1 $125 ,, 00 <br /> <br />$ :f. 2 ,.'..-'& 0~ <br /> $0.00 <br />$12,% 00 <br /> <br />RECEIPT NO: 58574 <br />TYF'E: CE CNECI\' ' ' ,i: 8,"')'"",_0 <br /> <br />PLAN REV];EW: BY <br /> <br />REMARKS: <br /> ,, ,. ,~,..,-,,¢,,...o,. :, ,~ , <br /> <br />OFFICE COPY <br /> <br /> <br />