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MARION COUNTY BUILDING INSPECTION <br />SENATOR BLOG. NO. 225 <br />220 HIGH STREET NE <br /> SALEM, OREGON 97301 <br /> <br /> PHONE: 588-5147 8:00 - 4:30 <br />24 HOUR CODE-AoPHONE: 588°7904 <br /> <br />~IGNATURE OF APPLICANT <br /> <br />OWfl£R:½~IE~ ~../~t94 T,-t;~,+~, ~.4,fl~&f4~ :'Y~'~6¥.' ...................................... ~; <br /> -r~t~ ~ ~ ¥ ,, ,_ f'~:~L.E~ ................................................. ~ E s ~ ~ E ~,~ 'f: ~ L <br /> <br /> AURORA ...... :" OR 97~82 HARION COUNTY NO <br /> <br />TYPE= ON-SITE SEWA6E WATER SUPPLY <br /> TE~T HOLES <br />PERNIT ~ APPLZCA~ON NO: 9~52~8 S~TE ~VA. UA~IOH <br /> EX~T~N~ TANK <br />COf,I[~AC'f'OF.;',,~ NO. EXISTING DRAIN FIELQ L]:NES: <br />HA'fHA~AY~ PHI:LIP ; .... ,S[~:~[C T~K PUHI:'ED: <br /> <br />;L9,566 ~U'f'TEVILLE RD ~M~:[N ~ES <br />PI.iONE~; 678-1857 <br /> <br /> '~ ':~ : QUANTITY <br /> II'EE .,, <br />~NNU~L EWL,. "- %E~P O~ 1 <br /> <br /> PAYEE: MR L. UDERMAN WA'~ <br /> RECE:~:¥ED BY: Ct ............... <br /> <br /> [;El,.!' AT'FACI.,IE2 DOCtJMEi,tT <br /> <br />F[)L, LOWIN(; MUST BE <br />~LL IqECESS~RY ZNFO~TZ8N <br /> <br /> $90,, Oe <br /> $¢ ,. <br /> $90 ,, ~)0 <br /> <br /> RECFIPT NO: ~ ~' ' <br />~YS-FIKM. <br /> REVIEW PROCE~S WHERE THE <br /> Al PL,,[C~.~N [ T0 THAT <br /> <br />FORM # MC 15-56 R~. 4/%'~3 OFFICE COPY <br /> <br /> <br />