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MARION COUNTY BUILDING INSPECTION <br /> SENATOR BLDG, NO, 225 <br /> ';'20 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~ lamaregi~teredbuilderOR( )the~uthori~edrepresentative SG A URE <br /> of a registered builder, <br /> <br /> ~U~SVit LF OR 77;~25 ~rON-COUN'I'Y ~lO <br /> <br /> ~'276~ ~ 60~ 3 [ VALUATION. <br />Co~ ~'~E6~'kT ....................... ~T6~--- TC~i~T ........... ~-6~'F ~F <br />~7 123 ~ 8s 12w JAR <br />J WIDTH; ~E~H' I~A; t UNIT~ IRREg. LOT: J ~ORNER: <br /> <br /> TYPE: ON-SiTE SE~ACE W~TEE SUPPLY= I:'W <br /> TEST HOLE~ <br /> PER~IT OR APPLICATION NO: ?ace717 SITE EVALUATION NUM~ER~ <br /> EXISTING TANK SIZE: <br /> COHTRACT(]R~ NO~ ~49~.~ EXISTING ORAIN FIEL~ LINES: 375 <br /> S'fAYIOW SEPTIC SEPTIC TANK PUMPE~: <br /> 411,,¢o STAYTOH SC[~ QR oL,,,,~ ,~E~8~ NO.,BE~ROOM,~. <br /> Sl AYTON, <br /> <br /> ' ' '~ ' ' QUANTITY A~ <br /> II~ ~ .',' , <br /> <br /> PAYEE OC~ A,RI[,II.-IU~A ', RECL,. r NO. <br /> kELE[VEQ BY: ~ :=,&,~,'~&, ",2~::==~i:~?;,~ TYPE.. CK CHECk <br /> SEE Al ~¢CI-IE~ DOCLJEEN'F F ;"QN=S'~iE,::tSEW~GE :SYS? <br /> <br /> F OWING H JSl' BE AFFLiCANT <br /> ALL NECESSARY INFORMATION: H~$;:BE~ ,¢~I,iD:E~.';:: >' ~:;?':' <br /> <br /> PI.AN I;d:iJV]:EW~' BY ....... DA~I'E ~ ~ ~t:TY JURISD"C1'~ON; ~Y DATE <br /> ~ :HAR ~,~,, o,~,, At,., [ <br /> <br />OFFICE COPY <br /> <br /> <br />