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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:$0
<br />24 HOUR CODE-A-PHONE: 588-7904
<br />
<br />lamaregi~teredbuHderOR( }theautherizedrepresentatlve
<br />of a registered builder.
<br />The work will be per[ormed by a registered builder.
<br />Other , ,,
<br />
<br />SIGNATURE OF APPLICANT;
<br /> DATE: .......
<br />
<br />i sJTu'~ FfESZDENTI AL
<br />
<br /> N0 0F BEDB00MS
<br /> 4
<br />, ..... ,,, ........................... , ,.,.,, ~ .................................... ,_.. ,~,
<br /> ADDRESS; SUBDIVISION;
<br />
<br /> :1.5861 P~RK
<br /> ~LIF(Ot~ O',:~ ~ SITE NU~BER:
<br />
<br />_Ot~ ~ 8LOC K'. S~OTJO~ ~ ~ ~'~ ~-~ MAP:
<br />f )37 212 ~ 29468. i BF JNO N0
<br />
<br />TYPE: OH-SITE SEWAGE ] WATER SUPPLY: CW
<br /> ~ I TEST HOLES READY:
<br />PERMIT OR APPLI~TIOH_NO: 706fii776 ~] SITE EVALUATION NUMBER: 35B2D
<br />
<br />,,,,e~7 ~'~ or' ::~::,;:; PREVIOUS NO. BEDROOMS:
<br />
<br /> ]:TEN ~U~NI'Z'f'Y aHOU:4T
<br />STAN~AR~ OH-SITE SYSTEM:
<br /> · ' , :. 1 $28~,, 88
<br /> ,<~:, ;:~,:
<br />
<br /> :::EEES $288,, ~8
<br />
<br /> PAYEE: Davi~ Snodder]y :I ; I : : : INVOICe- ~n ' ~a"~
<br /> RI-".f.k~,VE, D BY. I M ................. ~,.~2:2:~'~:~2~:~.__,,~ ::TYPE: IN CHECK ~:
<br />
<br />., TH s. S A ..................
<br />r'gi.,LO[rJ]N~e~j~(~ ~E ~?~PI,,ET:E~:" ~:' ~::S',,~I;HE ,:::RE~PbBO:~'gZ ZTY OF "HE ~PPLZCaNT TO aS :dj T-.AT
<br />ALL. NECEaa~I:W INFO~HaTZON:HaS::,SE~N
<br />
<br /> W,.;ZMARKS~: ,2SsSTO ,., SNOTE~ NO ,<E.~r,,~IID.(CAIEO ON SITE PLAN
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<br />OFFICE COPY
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