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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 />of a registered builder, <br /> <br />Other <br /> <br /> fi'iL'E' <br />SIGNATURE OF APPLICANT; <br /> <br />I ~tus ~g~st CLARA ......... "-"~-. <br /> ['CONTRACT CITY; ! UGB; iOCCUPANT LOAD: <br /> <br />:USE OF BU LO NG; <br /> NO OF BEDROOMS <br /> <br />' ~u.~ ~6~Fs~: ..................................... <br /> <br /> /',:J~4,~ PARK AVE <br /> ~UROR~ OR SITE NUNBE~: 95-~288 <br /> j V~I..UAT~ ON: <br /> LOT; BLOCK'. } ~C~'ON'. ~ TO~'6~h~:' ~'~; 1 Z~[ ~ MAP: <br /> <br /> wmDTU DEPTH I ~A U~l~: '~m~. LOT'. ~ ~R~n "J <br /> , <br /> <br /> TYPE: ON-SITE ~EWAG~ WATER SUPPLY; CW <br /> TEST HOLES REAJDY: <br /> PERMIT OR APPLICATION HO: 6~7~6 S[I'E EVALUATION NUM~E.R." <br /> EXISTIN(; TANK SIZE: <br /> CO)'I'~'RAC, TOR, biO. ~3~1~ EXISTING DRAIN F'IELD L1NEo.~"" <br /> ,~22~ L, AK~:~ LAS;:SH hie i PREVtQUS NO. BEDROOMS: <br /> <br /> ~ THI~ iS A VALI9 PERMIT ~ :~H~S'PERMtT EXPIRES <br /> ,,~ : ...... . ..... : .... ROM ITS ISSUE DATE. iF <br />ZON]:H60RDZNAN~.ES, THI~) ............................. "*' <br /> <br />By <br /> <br />OFFICE COPY <br /> <br /> <br />