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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLDG, NO. 226 <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 a registered builder OR ( ) the authorized representative <br /> <br />( ) Tha work will be pedormed by a regi~terad builder, <br />( ) Other <br /> <br /> j SU EDtVISION; <br /> <br />BOX 7:158 <br />., ICI FY OR ?7843 SITE NUH~ER: <br />PHCU,15 ~ 656....68:1. 9 j VALUATION: <br /> <br /> , . , , <br /> ~ ....................................... ~..._L ~_~c ......... ',. No ............ i ~o <br /> <br />TYPE: ON-SITE SEIJA6E WAI[',R ,:~[.JFFI_Y. pw ......~. <br /> <br />PER~[T' OR APPLICATION Ha: 9~61164 SJ;TE I[VAI.,UAT]:ON I,IU~ER: <br /> EXISTING TANK SIZE: <br /> <br />AC~ SF:PT~C ~ ~ ................ ,,,. .... :', ,,SEPTIC ,JANK PUMI <br />P 0 BOX 9eel ~ ~ F'REV~OUS NO, BE~ROOHS: <br /> <br /> ITEM .... I:4IANT :i TY AH(:/~ h,!'¥' <br />· ~TD oNSI'rE SYS ( 1888 GAL 1, <br /> <br />PAYEE,,", AbE .......... SE~Ttc , <br /> <br />SF,{,: A7 rAOHE. D I)(JC[..I~I2bI1 ~FC ;E SYSTEM,, <br /> <br />I,tO']'F:,", 1, ,L,,~ DOLt!; NOT <br /> <br /> OFFICE COPY <br />FORM # MC 15.56 REV. 4/90 <br /> <br /> <br />