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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 />
<br />of ~ registered builder,
<br />
<br /> ..... _,; .... j SITE NUNBE~:
<br />'::'Hf:)kEi: ...~,L ,1,, /,- I VALLJA')-ION~
<br />
<br />TYPE: DH-SITE SEWAGE
<br />
<br />PERR'rT OR APPLZUATZON
<br />
<br />CO 'iT'.:;'ACTOR,, !'i{:i,,
<br />C~AKI,,;:Y, RE]DNEY &
<br />S4~IE
<br />
<br />F:'HONE~:
<br />
<br />WATER SUPPLY." F'W
<br />TEST i. iOL, ES READY;
<br />S]','?i:: EVALUA'!-]:DN NUHI~I-'_.']4':
<br />,SX ].ST ]:NG TANK
<br />EX]:S ~'.~ ~c DRAIN
<br />SEP'T]C TANK i;;'U~F'ED
<br />PREVZOLJS NO,
<br />
<br /> 't' T !!:'i'~ il!l,lAt,l'!' )i '1 Y
<br /> Ai'.'NLIAt.,. I:V!M..,, '-" ~'E.~I'-" F~R H~) ..... ~I,: 'i
<br />
<br /> 'OTAL A.:,,~E:.oSE,. I-E:.~:.,:, S90.
<br /> F RI.V_ .) ..'~ RECEIPTS
<br /> Ti-ii.c; , EL,E.I. PF
<br />
<br /> BAI ANniE DUE S~,,
<br />
<br /> F'AYE'E~ PI..ANI,I]],E; DEPT TRANSFERE Id.X,,L,~,F ~ NO; ,~.~.31:,..
<br /> ~ ....... ~V:.D ~, ( .... TYPE: :IN CHECK "'-,,
<br /> SE:E YTTACHE~ DOgLJFd:.N[ ..... FOR F~;gb,[h=N~:.dTa;~ ........... OF Ol~-:~.~E 8EB~GE SYS'f~:d
<br />
<br /> ~ THIS IS NOT A PER~ZT. THI~ APPLICATION ~UST ~0 THROUGH A REVIE~ PROCESS WHERE THE
<br />· ' ,..L~.NL.hL, h,x ~ BE [ ............. D. ZT IS THE R~:,~, ~ 4., .~'..IL[[ OF THE AF'Pi_.]:CANT TO ~SS~:;'E ....
<br />ALI_ ' .... $E AkY INF~]R?~AT'.(CI~ HA? BEEN PROV~DE~.
<br />
<br />f,:'EHAF;:,:S: H['xJF .... !,(E].-]DS; F'iJ'"'F L_E:'f't'E::( N*,'.iJ:LEO
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<br />.. ; UIkTSDTCT 'J' '~N~ ~: Y .......................... O** fl::, .............
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<br />OFFICE COPY
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