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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: 588-8147 8:00 - 4:30 <br />24 HOUR CODE-A-PHONE: 588:7904 <br /> <br />I am performing work on a roperty I own or occupy, <br />I am a registered builder O~ ( ) the authorized represent*tire <br />of a registered builder, <br />The work will be performed by a reglstered builder. <br />Other <br />I have read and agree to the terms stated on the reverse side of <br /> <br />i '~g~ R TAX LOT: CATEGORY'. <br /> FISHER~ NATNAN RESIDENTIAL <br /> <br /> 12~22 FRY RO NE [~f~-~7~' <br /> AURORA' OR 97882 ~ARION COU4TY~ NO <br /> <br /> SITE NUHBER: <br /> PHONE: ~78-2247 VALUATION: <br /> <br />......................"1 ............. ................ .......... ................... 'T <br /> <br /> ..................................................................................................................... <br /> <br />TYPE: OM-SITE SEWAGE <br /> <br />PERMIT OR APPLICATION <br /> <br />?~5134~ <br /> <br />CONTRACTOR. NO. <br />FISHER~ NATHAN <br /> <br />PHONE: 678-2247 <br /> <br /> ITEM <br />AUTHORIZATIOI~ NOTICE <br /> <br /> WATER SUPPLY: PW <br /> TEST HOLES READY: <br /> SITE EVALUATION NUMBER: <br /> EXISTING TANK SIZE: 1000 <br /> EXISTING DRAIN FIELD LINES: <br /> SEPTIC TANK PUMPED: 11/1I/9~ <br />.,,~, ~.. ,,,_,,.,~, ,,I~.~:~.,._,,;,::.i,~..~4.'.'pRE~Sl~..:NO{ :,'~BEDROOMS: <br /> <br /> (~UANTITY <br /> 1 <br /> <br />FEES <br /> <br />2~6 <br /> <br />AMOUNT <br /> <br /> $0.88 <br />$I&0.00 <br /> <br /> PAYEE: FISHER, <br /> RECEIVE~ BY: <br /> <br /> SEE ATTACHED O06UMENT/ <br /> <br /> * THIS IS <br />FOLLOW,NC HUST ~E <br />ALI. NECESSARY INF~RHOTI~ <br /> <br /> §3769 <br /> TYPE: CI( CHECK 8: 1644 <br /> <br />~YSTEM. <br /> <br />A REVIEW PROCESS WHERE THE <br />tHE APPLICANT TO ASSURE THAT <br /> <br />F'LAN REVIEW: BY <br /> <br />REMARKS: <br /> <br />BY .............................. gATE .................................... <br /> <br />~oR~ # MC ~s-~ .~v. ~ OFFICE COPY <br /> <br /> <br />