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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 /> I am performing work on a property [ own or occupy, <br />) <br /> of A registered builder, <br /> <br />ADDRESS: <br /> <br />9180 SMI'fH Ri) <br /> <br /> SE <br />97725 <br /> <br />TAX LOT; CATEGORY: <br />57656-V,~0 kESIDENT:EAL <br />CONSTRUCTION TYPEi OCCU EANCY: <br /> <br />CONTRACT CITY'. UGB'. OCCUPANT LOAD'. <br />MARION COUNTY NO <br /> NO OF BEDROOMS: <br /> <br />:i, 298 EWAL.I) AV SE <br />~AL.E~% OF: 973rFI2 <br />FHONE: 585'"'4861 <br /> <br />SITE MUI~BER: 94-0013¢ <br />VALUATION: <br /> <br />TYPE= ON-SITE SEWAGE WATER SUPPLY;i PM <br /> TEST HOLES READY: <br />PERMIT OR APPLICATION NO: 583~2 SITE EVALUATION NiJNBE~: <br /> EXISTING TANK SIZE: <br />CONTRACTOR,~ N[]. 86727 ~XIST~N6 DRAIN FIELD LINES: <br />Wt?i{'ewa':er U~:lergro~d <br />39~,4 46t:'h Aw4~ NE" <br /> <br />F'HONED ~78-~:L77 ;. <br /> <br />S'iANDARD ON--SITE ,~YStTH <br /> <br /> PAYEE';: <br /> <br /> . ' TACHED DOLUHENT <br /> <br />COhISTR~CTION FAIL, S T0 <br />ZON:I:I16 ORI) Z I'IAI'IC E S,¢ <br /> <br /> ':' RECEIPT NO: <br /> i; TYI E,, CHECK ~. 0 <br /> SYS'f'EH. <br /> <br /> ITS ISSUE DATE. IF <br />AND NAR]'.ON COUNTY DtJIL~);[NG <br /> <br />DONALD I!E.,, ~00DLE:_'Y~ ~A~):Sh t:,JUNT( BUJ.,.DIIIf; 0~-klC.,.AL,. / B'Y ". .................................................................. <br /> <br />FORM # MC 1S.r.~ REV. 4/90 OFFICE COPY <br /> <br /> <br />