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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG. NO, 225 <br />2'~0 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 a registered builder OR the au horized represen ave <br />of ~ registered builder. <br />The work wtll be performed by a registered Suildsr. <br />Other ..... <br /> <br />this document. <br /> <br />SIGNATURE OF APPLICANT; <br /> DATE: <br /> <br /> 91.84 GOL. F' CLUB RD SE CONTRACT OITY'. ]OCCUPANT LOAD; ~ <br /> AUI'fSV'.[I_.LE 0R 9732J HA~ION COUNTY NO <br />USE OF BUILD~NGI NO, OF BEOR00M$: <br /> <br />LOT: <br /> <br />PHONE: 749-29&8 <br /> <br />SiTE NUHBER: B3-84878 <br />VALUATION: <br /> <br />TYPE: ON-SITE SEWAgE <br />PER~IT OR APPLICA'TI8N NO: <br /> <br />9B51617 <br /> <br />AC <br /> <br />WATER SUPPLY: PW <br />TEST HOLES READY: <br />SITE EVALUATION NUMBER: <br /> <br /> PNONE: 749-2968 ~ <br /> <br /> ITEN <br />::AUTHORIZATION NOTICE <br /> <br />' EXISTING TANK SIZE: <br />CONTRACTO~h~ NO. . I EXIST~,NG DRAIN FIELD LINES: <br />F'I~SON~ DESNOI,ID & EVELYN,, I PI~'V.~'OOS NO?BEI)ROOHS:UHPED' 1, <br /> <br />:!'~ QUANTITY AMOUNT <br /> 1 $160,. 0¢~ <br /> <br /> RECEIP~ NO: ,,5485e <br /> TYPE: CK CHECK 8: 24~6 <br />~YSI'EM. <br /> <br /> PAYEE: F'USON~ DESMO~ <br /> ~EI, EIVED BY: DN2 <br /> <br /> SEE ATTACNEQ DOCUNE~ <br /> <br /> ~ THIS IS NOT A <br />FOLLOWING HUST BE <br />ALL NEOESSAEY INFORMAl <br /> <br />A REVIEW PROCES~ ~HERE THE <br />NE APPLICANT 'fO ASSURE THAT <br /> <br />DATE <br /> <br /> <br />