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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 8 proper ¥ I own or Occupy. <br />I am ~ registered bullder OR (~h~e authorized representative SIGNATURE OF <br />of a registered builder. <br />The work Will be performed by a registered builder. <br />Other <br />I have re~ and agree to the term8 stated on the reverse side of DATE; <br />this document. <br /> <br /> 5~77 SHAW CENTER PL SE ~ CONTRACT CITY'. J '~; ~OOOUPANT LOAD: <br /> <br />89~? SH~ SQURRE R~ SE <br />AUMSVILLE OR 97325 SITE ~BER: 94-03723 <br />PH~E: 585-2218 VALBATIQN: <br /> <br />TYI~Ec ON-SITE SIEI~GE tWATER SUPPLY: PW <br /> ~ TEST HOLES READY: <br />PERNJT ~ APPL, JCATIOH HO: ?S"~f4~'31~ ~ SITE EVALUATION NUHSER: 49744 <br /> ~ EXISTING TANK SIZE: <br />CONTRAC[OR~ ldO. J EXISTING ~RAlN FIEL~ LINES: <br />WILLIANS~ FRANKLIN ~. <br />8~ SHA~ SQUARE ~D SE,:? i PREVIOUS NO. BEDROONS: <br />Au~SVILLE OR 7732~ <br />PHONE: 585-221~ .i'!! :: <br /> <br /> iTEH <br /> QUANTITY <br />OAPPING FILL I <br /> <br /> PAYEE= WILL~AMS~ <br /> RECEIVEDBY. mb <br /> <br /> SEE ATTACHED DOCUMENT <br /> ~ THIS ISHOT A PERHIT~ <br />FOLLOWING NUST BE <br />ALL NECESSARY iNFORMATIC <br /> <br /> PLAN REVIEW= <br /> <br /> RE~A~KS: SS;CF <br /> <br /> AMOUNT <br /> $425.80 <br /> <br /> $425.00 <br /> $0.08 <br /> $425.08 <br /> <br /> $0.00 <br /> <br /> RECEIPT NO: 60938 <br /> ,':TYPE: CK CHECK ~: 1812 <br /> <br />S¥STE~. <br /> <br /> REVIEH PROCESS WHERE THE <br /> APPLICANT TO ASSURE THAT <br /> <br />: : CTION: BY . ~ DATE <br /> <br />OFFICE COPY <br /> <br /> <br />